CHARLESRILEYPORTFOLIOCLASSSKILLSINVENTORYCORECOURSESCOURSE SKILLLEARNED DESCRIPTIONOF

SKILLUSETABBEDSKILLAREA

ARTIFACT

NUTR1100 Assesscomponentsofthecurrentfoodsystemsandutilizenewtrendstoaddressgaps.

Analyzethegrowing,harvesting,processing,packaging,transporting,marketing,consuming,anddisposingoffood/foodpackages.

FoodSystems

NUTR1000 Utilizenutrientanalysissoftware.

Utilizepatientdatawithinsoftwareplatformtoanalyzedietaryintakesandcreatenutritionrecommendations.

FoodandNutrition

NutrientAnalysisProject.

NUTR2000 Addressnutrientneedsacrossthelifespan,includingcriticaltimeframes.

Assesspatientneedsatallpointsacrossthelifespanandcreatecomprehensivenutritionintakeplansaccordingly.

FoodandNutrition

ReflectiveJournal/InterviewwithElderlyPatientontheImportanceofNutritionCare.

NUTR2200 Analyzethescientificprinciplesappliedtoselection,storageandpreparationoffoodswithemphasisonfoodmacromolecules.

Preparevariousfoodproductswithmodificationstoanalyzetheeffectsoffoodmakeuponquality,structure,andproperties.

FoodandNutrition

Areviewofnutrientsupplementationintheclinicaltreatmentofdiabetesmellitus.

NUTR2220 Analyzethescientificprinciplesappliedtoselection,storage,andpreparationoffoods.

Preparefoodproductswithmodificationstoassesstheusefulnessoffoodprocessingandpreparationtechniquesonnutritioncare.

FoodandNutrition

Areviewofthefeasibilityofzincandmagnesiumsupplementationinproductsforuseintypeonediabetestreatment.

NUTR2990 Developmentofanawarenessofthephilosophy,goals,organizations,andrequirementsoffood,nutrition,andappliednutritionprofessions.

Prepareacomprehensiveprofessionaldevelopmentportfolioforuseinentrancetonutritionandfoodsciencefields.

ProfessionalDevelopment

NUTR3000 Examinationofthemacro-andmicronutrientsfromascientificstandpoint,includingtheirdigestion,metabolism,andutilizationatthecellularlevel.Evaluationoftherecommendedintakeforthepreventionofchronicdiseaseandhealthmaintenance.

Examinetheclinicalandphysiologicalimportanceofindividualmicro/macronutrients.

FoodandNutrition

Reviewofthephysiologicalandnutritiveimportanceofzinctranscribedpresentation.

NUTR3100 Identifytheimportanceofmedicalnutritiontherapyonthepreventionandtreatmentofdisease,includingoverweight/obesity,hypertension,hyperlipidemia,diabetesmellitus,andkidneydisease.

PreparationofnutritioncareplansforHypertensive,Diabetic,Obese,andKidneyDiseasePatients.

NutritionCareProcess

NutritionCarePlanforHypertensivePatient.

NUTR3600 Applythetheoryofmedicalnutritiontherapy(MNT);communicatinghealthandnutritionadvicetoconsumers;andbehaviorchangemodelsusedinMNT.

Creationofeducationtoolsandclinicalcareguidesforuseinmulticulturalnutritioncareinteractions.

CounselingandEducation

CulturalAnalysisofPacificIslanderPopulationPresentation.NutritionEducationToolwithTypeIdiabeteswithVeganDiet.

NUTR4000

ApplyprinciplesofMedicalNutritionTherapytothecommunitysetting,foodsystems,environmentalnutrition,foodpolicy,andcommunityhealth.

Assessmentofspecificnutritiveandfoodneedsofahighlyspecificpopulationinasemi-isolatedcommunity.

FoodSystems

AssessmentofFoodAccessibilityinTypeIdiabeticchildreninSouthEasternOhio.UNworldfoodprogramagencyeducationalreview.

NUTR4100 Identifytheimportanceofmedicalnutritiontherapyinregardstothepreventionandtreatmentofdisease,includinggastrointestinal,pulmonary,andwastingdiseases,Enteralandparenteralnutrition.

PreparationofNutritionCareplansforGastrointestinal,CysticFibrosis,Immunedeficient,andCancerpatients.

NutritionCareProcess

NutritionCarePlanforB-LymphomaPatient.NutritionCarePlanforGIPatientfocusedonOstomycare.NutritionCarePlanforCysticFibrosisPatents.NutritionCarePlanforImmunocompromisedPatient.CysticFibrosisandPancreaticFunctionEducationalHandOut.

NUTR4901 Demonstrateprofessionaldevelopmentandgrowthinthefieldofnutritionandfoodscience.

Refineprofessionaldocumentsandprofessionalportfolio.

ProfessionalDevelopment

SCIENCE/ANALYSISCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF

SKILLUSETABBEDSKILLAREA

ARTIFACT

BIOS1700 Introductiontothechemistryoflife,cellstructureandfunction,andtheprinciplesofinheritance.

Applyprinciplesofbiologytoconductexperimentsrelatedtobasicgenetics,cellularprinciples,andnaturalselection.

Biology BIOS1705BIOS1710BIOS1715BIOS2210 Introductionto

thehistoryandlifeofmicroorganismswithanemphasisonbacteriaandviruses.

UtilizeprinciplesofmicrobiologytoconductproperlaboratorytechniquestoprepareandanalyzeBiohazardLevel2organismsamples.

Biology BIOS2215

BIOS3010 Structureandgeneralfunctionofallbodysystemswithemphasisonhumanmusculoskeletalsystem,andhumanstructure/functionrelations.

Utilizeprinciplestoconductdissectionsandcadaverobservationstobetterunderstandtheinnerworkingsofthehumanbodyanatomically.

Biology BIOS3015

BIOS3100 Principlesandconceptsofgeneticsasrevealedbyclassicalandmoderninvestigation.

Applycomplexgeneticstoanalyzetheeffectsofgeneticmanipulationandtheeffectofenvironmentalfactorsongeneticmake-upandgeneexpression.

Biology

BIOS3450 Basiccellphysiologythroughmostorgansystems,particularlythoseofhumans.

Conductphysiologicaltestingonbodyfluids,gasexchange,muscleandorganmodelstobetterunderstandcellularandbodilyfunctionsofthehumanbody.

Biology BIOS3455

CHEM1500 Generalcourseinfundamentalchemicalprinciples.Atomicstructure,periodicclassification,bonding,moleconcept,stoichiometrywithproblemsolving,thermochemistry,equilibrium,andgases.

Utilizebasicchemicalprinciplestoconductanalysisofphysicalandchemicalproperties.

Chemistry Determinationof%FluorideintoothpastesamplesusingFluorideIonSelectiveElectrode(FISE).DeterminationofHalfCellPotentialofFerricyanideusingDifferentialPulseVoltammetry.

CHEM1510CHEM1520CHEM2410

CHEM3050 GeneralOrganicchemistryincludingbonding,orbitals,separationtechniques,andexperimenttechniques.

Demonstrateunderstandingoftheprinciplesoforganicchemistrythroughsynthesisoforganicmoleculesinalaboratoryenvironment.

Chemistry LabSafety,procedure,andexecutionsheet.

CHEM3060CHEM3080

CHEM4890 Introductiontobiochemicalconceptsandtechniques,metabolicpathways,andinformationstorageand

Synthesizepreviousunderstandingofbiologyandchemistrytoexplainenzymaticandmetabolicprocessesin

Chemistry

transmission,withemphasisondirectionsofcurrentbiochemicalresearch.

termsofbothplantsandanimals.

MATH1200 Equations,

functionsandgraphs,includinglinearequationsandsystems,polynomials,rationalandradicalexpressions,quadraticequations,exponentialandlogarithmicfunctions,andinequalities.

UtilizeprinciplesofAlgebraandCalculustoapproachcomplexproblemsinanabstract,logicalfashion.

MathematicalReasoning

MATH1350

PHYS2001 Mechanicsof

solidsandliquids,oscillations,heat,thermodynamics.

Demonstrateanunderstandingoffundamental,universalpropertiesofmatterinalaboratoryenvironment.

Physics PHYS2002

PSY2110 Descriptiveand

inferentialstatisticswithemphasisoninferentialstatistics.

Applystatisticalanalysistoconductquantitativehumansubjectresearchinthecollegesetting.

GeneralEducation

BUSINESSCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF

SKILLUSETABBEDSKILLAREA

ARTIFIACT

MGT2000

Understandingofandpracticeinsolvingproblemsfacingmanagersandadministratorsusingconceptsandprinciplesfrombehavioralsciencesandotherapplicabledisciplines.

Applybusinessanalyticstoaddresscomplexbusinesshierarchiesandmachinations.

Businessanalysis

MGT3300

Surveyofhumanresourcemanagementpracticesinareasofhumanresourceplanning,recruitment,selection,traininganddevelopment,performanceappraisal,compensation,discipline,safetyaudits,andpersonnelresearch.

Applyprinciplesofhumanpsychologyandcommunicationtodiffuseconflict,attractclientsandassociates,andadheretobusinesspolicy.

Businessanalysis

SOCIALSCIENCECOURSESCOURSE SKILLLEARNED DESCRIPTIONOF

SKILLUSETABBEDSKILLAREA

ARTIFACT

ANTH1010

Analyzethesimilaritiesanddifferencesinlocal,regional,andglobalculturesinawaythatallowsfortheflowofideasandprinciples.

Conducthumansubjectresearchfocusedonculturaldifferencesinthecollegeenvironment.

GeneralEducation

PSY1010

Surveyoftopicsinexperimentalandclinicalpsychologyincludingphysiologicalbasesofbehavior,sensation,perception,learning,memory,humandevelopment,socialprocesses,personality,andabnormalbehavior.

Utilizetopicstobetterunderstandbasicandcomplexhumaninteractions.

GeneralEducation

COMS1010

Introductoryanalysisoforalcommunicationinhumanrelationshipswithfocusonvarietyofcontextsincludingdyadic,smallgroup,andpubliccommunicationexperiences.

Utilizeprinciplestobuildbetterrelationshipsandmethodsofcommunication.

GeneralEducation

Interpersonalawarenessanddevelopmentactivity.

GENERALEDUCATIONCOURSESCOURSE SKILLLEARNED DESCRIPTIONOF

SKILLUSETABBEDSKILLAREA

ARTIFACT

ENGL1510

Writinginanargumentative/passivefashioninawaytoallowsfortheflowofdiscoursebetweendisciplinesandcultures.

Communicateinafashionthatallowsfortheformulationofcomplexviewpointsfromdifferingstandpoints.

GeneralEducation

HLTH2300

Decomposemedicalterminologyinawaythatleadstooverallunderstandingofmedicaldiscourse.

Communicateinaprofessionalmedicalenvironmentinproperform.

GeneralEducation

EXTRACURRICULARACTIVITY

SKILLLEARNED DISCRIPTIONOFSKILLUSE

TABBEDSKILLAREA

ARTIFACT

AmericanDiabetesAssociationLivingwithDiabetesIncollegeseries

Professionalcommunicationmediatedthroughanorganizationalpartner.

LeveragedbyCollegeDiabetesNetworktowritepieceonDiabetesinCollegeintheireducationalblogseries.

ProfessionalWriting

LivingwithDiabetesinCollege:Charles.

RecommendationtoAADEontransitionaldiabetescarefromchildhoodtoadulthood.

Informingstandardsofpracticeinahealthcaresettingasitrelatestotransitionofcare.

Informedorganizationalandclinicalpartnersastostandardofcarefromthepatientpointofview,andhowthatcanbeleveragedtoprovidebettercare.

ProfessionalWriting

AADEClinicianCareguideforOmnipod.

ProgramProposaltotheAssociationonHigherEducationandDisability

Workingwithaninterdisciplinary,multi-organizationalteamtoproduceeffectiveprogrammingandpolicy.

GeneratedprogramproposalforpresentationatAHEAD2016conference.

ProfessionalWriting

2016CollegeDiabetesNetworkAHEADProposal.

EducationalToolDevelopmentforthoselivingwithTypeIdiabetesinCollege

Workingwithinaresearchteamtoproduceaneffective,resultsbasedtooltoincreasequalityoflife.

Generatededucationaltoolsforuseinaspecificpopulation.

ResearchandProgramDevelopment

DiabetesFactSheetforStudents.

Studytogaugeknowledgeabilityrelatedtodiabetesmellitus

Analyzingbulkdatatofindandcomparetrendsinknowledge

Conductedhumansubjectsresearchtodeterminewhereeducational

ResearchandProgramDevelopment

DiabetesOutreachSupportandEducationfor

atOhioUniversityMainCampus.

baseandassessknowledgedeficits.

materialsneededtobefocused.

StudentsinCollegeKnowledgeabilityStudy.

EducationalToolDevelopmentforFacultyastohowtocreatea“Diabetes”friendlyclassroom.

Gaugingthediscoursebetweenstaff/facultywithstudentslivingwithTypeIdiabetestodiscerngaps.

Interviewedstaffandfacultytodeterminewherethenormwasfailingandwhatcouldbeimproved.

ResearchandProgramDevelopment

CreatingaDiabetes-FriendlyClassroom.

Tabs:BiologyBusinessAnalysisChemistryCHEM2410Determinationof%FluorideintoothpastesamplesusingFluorideIonSelectiveElectrode(FISE)

Introduction

Fluorideisanionthatoccursnaturallyandisregularlyaddedtodrinkingwaterandtoothpaste.Theionisimportantinnaturaldevelopmentofstrongbones.FluoridemustbeconsumedinproperquantitiesorDentalFluorosis;afluorideimbalancemayoccur.Whenfluorideintakereachesextremelevels,kidneydysfunction,poorbonedevelopmentanddeathmayoccurduetotoxicity.Thismeansthatfluoridemustbeproperlymeasuredtoensurehealthyintake.Potentiometricmethodsinvolvethemeasurementofthepotentialofanelectrochemicalcellwithoutdrawingacurrent.Potentiometryisamongthemostcommontypesofanalyticalmeasurement.Theapplicationofpotentiometryrangesfrommeasuringwaterpollutants,measuringmineralconcentrationswithinthebodyorfood,tomeasuringtheamountofCO2dissolvedinseawater.InthisexperimenttheFluorideIonSelectiveElectrode(FISE)willbeemployedtodeterminetheamountofFluorideinatoothpastesample.TheelectrodeinFISEisasolidstate,crystallinemembraneelectrode,whichcanmeasuretheconcentrationofthefluorideioninsolution.Theelectrodeismadeof

asinglemembranecomposedofLaF3withaddedEu2+toincreaseconductivity.Areferenceelectrodeisalsohousedinternallywhichisbondedintoanepoxybody.Thecrystalintheelectrodeisanionicconductorwhichonlyallowsforthemovementofthefluorideion.TheFISEisveryspecificandcanbeeffectedheavilybytemperatureandpH.Itcanbeeffectedasheavilyas2%witha1degreeCelsiuschangeintemperature.Whentheelectrodeisplacedinasolution,themovementoffluorideionsacrossthemembranegeneratesapotentialacrossthesurfaceoftheelectrode.Thispotentialisdependentontheactivityofthefluorideionsinsolution.Thepotentialcanbemeasuredagainstthereferenceelectrodeusingavoltmeter.ThisrelationshipcanbedescribedandillustratedwiththeNerstequation.

E=K-0.0592*log(aF-) Equation1

E=measuredmembranepotential,K=electrodeconstant

aF-=fluorideionactivityinsolution.

Theactivityofanioncanalsobedescribedastheeffectiveconcentrationoffreeionsinsolution.Inthiscase,theactivityoffluorideions,isdescribedastheeffectiveconcentrationoffluorideionsinthesolutionbeingtestedwithFISE.Thetotalionconcentrationofthesolutionbeingtestedincludesbothfreeions,andsomecomplexedions,howevertheelectrodeisonlycapableofrespondingtofreeionsinsolution.TheactivitycoefficientrelatestheactivityoftheFluoridetotheconcentrationoffreefluorideions;

aF=g*CF Equation2

Ionicstrengthisameasureoftheconcentrationofallionsinsolution.Ionicstrengthisadeterminantofionicactivitycoefficients.

m=½SCiZi Equation3

Ci=concentrationofioniZi=chargeofioni.

TheFISEelectrodecanalsorespondtothefluorideionswhichhavecomplexedwithmetalions(commonlyAluminumandIron).Thesecomplexescaninterferewithreadingsoftheelectrodesifpresentinlargeenoughconcentrations.ThisinferenceisdescribedwiththeNikolskii-Eisenmannequation:

Equation4

K=electrodeconstant,R=idealgasconstant,

T=temperatureinKelvin,Zi=chargeontheionofinterest,

ai=activityofspeciesi,aj=activityofinterferingionjwithchargeZj,

kij=selectivityconstantoftheelectrodeforioverj.

Theselectivityconstantisrepresentativeoftheamountofinterferenceduetocomplexedmetal/ionspresentinthesample.TheresultsofourexperimentvalidatedtheNerstequation,andthedifferenceinFluorideionsdeterminedanalyticallyandtheamountofFlourideionsreportedbythetoothpastcompanywasdeterminedtobeapproximately11%.

ProcedureTheexperimentwasconductedaspertheinstructionsprovidedinthelabhandout:ExperimentIV,FISE,CHEM2410L,FallSemester2016.Theprocedurewascompletedtospecification;noalterationsweremade.Table1:InstrumentsEmployed

Instrument Model# CompanyVoltmeter N/a N/aStirrer N/a N/aFluorideElectrode N/a N/a

Table1includesallinstrumentsemployedtoconducttheFISEexperiment.Table2:ChemicalsEmployed

Chemical Supplier Lot# MolecularWeight ExpirationDateSodiumFluoride N/a N/a 41.98817 N/aSodiumChloride N/a N/a 58.44 N/aTISAB N/a N/a N/a N/aToothpaste N/a N/a N/a N/a

Table2includesthechemicalsemployedtoconducttheFISEexperiment,allinformationavailablewasprovidedintable2.

( )( ) úûù

êëé +÷÷

ø

öççè

æ+= j

iZ

Z

jijii

akaFZRTKE log303.2

Table3:AmountsofReagentsUsedReagent AmountUsedSodiumFluoride 0.04199gSodiumChloride 0.5260gTISAB 50mL

Table3includestheamountofeachreagentusedtoconducttheFISEexperimentingrams.PreparationofStandards:PreparationofStockSolution:

0.100L*0.01mol/1L*41.9881g/1mol=0.04199gNaF+0.5268gNaClSerialDilutionPreparation

IonicStrength AddedNaCl0.001M–10mL0.01M 0.5260gNaCl0.0005M–50mL 0.001M 0.2922gNaCl0.002M–40mL0.0005M 0.3507gNaCl0.0001M–50mL 0.0002M 0.2922gNaCl0.00005M–50mL 0.0001M 0.2922gNaCl

ResultsandDiscussion

Figure1:FluorideCalibrationCurve

y=56.964x- 289.68R²=0.99348

-200 -180 -160 -140 -120 -100 -80 -60 -40 -20 0

1 1.5 2 2.5 3 3.5 4 4.5

Potential(mv)

-logConcentration

Concentrationvs.Potential

Figure1demonstratestherelationshipbetweenthepotentialinmVandthe–logoftheconcentration.Figure1alsodemonstratesthevalidationoftheNerstequationastheslopeofthelineisnearthevalueof59.16mV.Table4:DeterminationofFluorideionpresent

LineEquation

UnknownPotential

(-)logconcentration

concentration(mM)

%fluorideion

%fluoridefromtoothpastetube

%difference

y=56.964x-289.68 -51 4.19 6.45654E-05 0.028%

0.24%11.85

Table4includesthedeterminationoffluorideionpresentinthetoothpastesample.Thisdeterminationwasconductedusingtheequationofthecalibrationlineequation.Usingthisequation,alongwiththeaverageunknownpotentialfoundexperimentally.Usingthispotential,the–logoftheconcentrationwasfound,alongwiththeconcentration.Usingtheconcentration,the%fluorideionwasfoundandthe%differencebetweenthecalculatedpercentageoffluorideionpresentandthereported%fluorideionpresentwascalculatedtobe11%.Thisexperimentwasparticularlysusceptibletoerror,astwodifferentlabteamscollaboratedtocompletetheexperiment.Thisincreasedthepossibilityofexperimentalerrorasdatawaspassedbetweenmanyexperimentersandpossiblylostintransition.Therewasalsocertainlyanerrorinthecalculationsusedtocreatethestocksolutionandthedilutions.Duetoineffectivecommunicationbetweenthelabgroups,thecalculationdataismostdefinitelyincorrectinsomecapacity.Anothersourceoferrorincludesunanticipatedissueswiththetypeoftoothpasteusedincludinghighamountofmetalcomplexingwiththefluorideionsduetotheingredientsofthetoothpasteused.Inthefuture,theseerrorscouldbereducedbyreducingthenumberofgroupsconductingtheexperimenttojustonegroupatatime.Thelabcouldalsoprovidethetoothpastesampletostandardizetheexperimenttoeliminateissuesassociatedwiththeformularyofindividualtoothpastesused.Inconclusion,the%offluorideionspresentinourtoothpastesamplewasobtainedbyexaminingstandardfluoridesolutions.Thiswasdoneusingacalibrationcurveandtheequationoftheline.Thevaluesoftheunknownwerepluggedintotheequationoftheline.Thedifferenceincalculatedvaluesandthegivenvaluewasfoundtobe11%.

Conclusion

Overall,thelabprocedurewasok.However,thebreak-upofworkbetweentwogroupsmadedatacollectionandcalculationsverydifficulttocarryoutasinformationwasnotequallyshared,norwasiteasytoobtainafterthefact.Wewereabletocarryouttheseprocedureswithissues,mainlyduetounequalsharingofinformationanddisarraybetweenthetwogroups.Thecalculationsandexplanationsarequitedifficultasaresomeofthetheorypieces,withouthavingabackgroundinelectrochemistry,andalsonothavingourelectrochemistrylecturesyet.Hopefullythisproblemcanbealleviatedinthefuturebyexpandingthequantitativelaboradjustingclasssizeandnotbreakingonelabbetweentwolabgroups.

Questions1. Overwhatrangeisyourcalibrationcurvelinear?

Thecalibrationcurveislinearovernearlytheentirerangeoftheconcentrations.Itraisesslightlynearthe3mMlevel,however,thisisnegligibleasthecorrelationcoefficientisnearly1.

2.WhatistheslopeofyourcalibrationcurveandhowisthisrelatedtotheNernstianequation?

Theslopeofthecalibrationcurveis56.964.Whenastraightlinewithaslopeof59.16mVisobtained,thenthenerstequationcanbesaidtobevalidated.Inthiscase,wecansaythatthenerstequationissatisfiedduetotheproximitytothetruevalue.

2. WhyissodiumcitrateaddedtotheTISABsolution?

Sodiumcitrateisaddedtocomplexwithpresentmetalionstopreventthemfromcomplexingwiththefluorideions,limitingtheinterference.

3. Whydoeshydroxideinterferewiththefluorideelectrode?

HydroxideinterfereswiththefluorideelectrodebecauseitcomplexeswiththeLaF3crystalitself.Thiscomplexinginterfereswithfluoridedetermination.

4. Whyarethesolutionstransferredtoplasticbeakers?

Theplasticbeakersactasaninsulatorbetweenthelabbenchandthesolution.Thisdisallowsinterferenceduetotemperature.

5. Whyisnonturbulentstirringrequired?

Toensureequaldispersantoffluorideionstotheelectrode.

References

1.Experiment1:CyclicVoltammetryofFerricyanide,LaboratoryHandout,FallSemester2016

2.Harris,DanielC.2010.QuantitativeChemicalAnalysis.8thed.Chapter16:Electrochemical

Techniques.W.H.Freeman,2010.CHEM2410DeterminationofHalfCellPotentialofFerricyanideusingDifferentialPulseVoltammetry

Introduction:

ThepurposeoftheelectrochemistrylabIIIwastolearnmoreaboutthetheory,procedure,andinstrumentsinvolvedinDifferentialpulsevoltammetry.Inthisprocedure,ourgoalistostudy

differentialpulsevoltammetry(DPV)byexaminingthereductionofferricyanidetoferrocyanide.Theequationofthisreactionisgivenas:Fe(CN)63-+e-⇄Fe(CN)64-.

TheinstrumentusedtoconducttheDPVexperimentwasthepoteniostat.Theelectrodesemployedweretheglassycarbonelectrodeastheworkingelectrode,theAg/AgClelectrodeasthereferenceelectrode,andthePlatinumwireastheauxiliaryelectrode.DPVisconductedasotherpulsetechniquesinthatthedifferencebetweenthedecayrateofthechargingcurrentandfaradaiccurrentdirectlyfollowingthepulse.Itisnoteworthythatthechargingcurrentdecaysinanexponentialfashionwhilethefaradaiccurrentdecaysatthefunctionofthesquarerootoftheinverseoftime(1/(time^(1/2))).Someothertermsofnoteinclude:

PulseAmplitude:HeightofrecordedPulse

PulseWidth:PulseDurationSamplePeriod:Periodattheendofthepulsewherethecurrentmeasurementistaken

PulsePeriod:thetimeofonefullpotentialcycle

Thepulsevoltammetryfieldincludesmanydifferentmethods,howeverthemostcommonarenormalpulse,differentialpulse,andsquarewave.First,thereisthenormalpulsemethodwhichinvolvestheapplicationofaseriesofpulsesofincreasingamplitudeoveradurationofbetween1and100milliseconds.Asimilartechniquetothenormalpulsemethodisthedifferentialpulse,whichinvolvestheapplicationofapotentialwhichiskeptatasmallerfixedamplitudecomparedtothenormalpulsemethod.Finally,thereisthesquarewavemethodwhichoftheapplicationofasymmetrical,squarewavepulse,whichissuperimposedonastaircasewaveform.Thenetcurrentforthismethodisobtainedbytakingthedifferencebetweenthenormal(forward)andreversecurrentandiscenteredontheredoxpotentialofthecompoundinquestion.

Whiletherearemanydifferenttypesofpulsevoltammetry,theexperimentfocuswasDifferentialPulse.InDPV,thepotentialisscannedwithaseriesofpulsessimilartoothertypesofpulsevoltammetry,however,DPVisdifferentinthatthepulseiskepttoasmalleramplitude(usuallybetween10-100mV).Thissmallpulseisthenmeasuredontopofabasepotentialwhichisslowlychangedoverthecourseoftheexperiment.Foreachpulse,thecurrentismeasuretwice:firstatapointbeforethepulseandagainattheendofthepulse.Atbothofthesepoints,thechargingcurrenthasbeenallowedtodecaytoensureaccuratemeasurements.Thedifferencebetweenthetwopointsatwhichthepulsewasmeasuredisplottedagainstthepotentialontheresultingvoltammogram.

InexperimentIII,thereductionofferricyanidetoferrocyanidewasstudiedusingthismethod.Withthisreductiveprocessinmind,theamplitudeusedforDPVwas50mV.Thepotentialwasthenchangedfrombasepotential,toamid-levelpotential.Thismid-levelpotentialwasmaintainedfor50msbeforebeingchangedtothefinalpotential.Whenthepotentialexceedsthatofthereductionpotential,nofaradaiccurrentisobserved,whichmeansthedifferenceinchargingcurrentandfaradaiccurrentiszero.However,whenthefaradaiccurrentreachesthereductivecurrent,thecurrentdifferenceismaximized,thendecreasesbacktozero.

DuetothenatureofDPV,thedetectionlimitismuchlowerthanthatofotheranalyticmethods.Thisisduetotheenhancementofthefaradaiccurrentandtheminimizationofthechargingcurrent.Becausethecurrentismeasurebeforeandafterthepulse,theratioofchargingcurrenttofaradaiccurrentisincreaseddrastically.Aftereachpotentialthechargingcurrentquicklydecaystozero,whilethefaradaic

currentincreasesatamuchslowerrate.TheenhancementofthefaradaiccurrentalsoincreasesthesensitivityoftheDPVmethod.Thepulsewillpropagateinthesurfacelayerofthesampleiftheelectroactivecompoundispresentbecause,accordingtotheNerstequationtheconcentrationmustdecreasewiththisnewpotential.

Equation1below,demonstratesthattheheightofeachpeakisproportionaltotheconcentrationoftheelectroactivecompound.

mp t

CnFADip

21

= Equation1

ip:peakcurrent(A),F:Faraday’sconstant,

A:workingareaoftheelectrode(cm2),D:diffusioncoefficientoftheanalyte(cm2/sec),

C:concentrationoftheanalyte(mol/cm3),tm:timeaftertheapplicationofthepotentialwhenthecurrentismeasured(sec)

AccordingtoEquation2below,ifthereactionisreversible,thepeakpotentialisnearlyequaltothestandardpotentialforthehalfreaction.

Ep=E1/2–DE/2Equation2

DE:pulseamplitude(mV).

Afterconductingthisexperiment,itwasfoundthatequation1and2werevalidatedbytheresultsobtained.Theconcentrationwasdirectlyproportionalwiththeheightofeachpeakachieved,andthepeakpotentialwasnearlyequaltothestandardpotentialofthehalfreaction.Theprocedureandresultsareshownbelow.

Procedure:

Theexperimentwasconductedaspertheinstructionsprovidedinthelabhandout:ExperimentIII,DPV,CHEM2410L,FallSemester2016.1Theprocedurewasfollowedtospecification,includingthedeoxygenationofeachsamplebetweentrialsbypurgingwithNitrogengas.Table1includesallavailableinformationregardingtheinstrumentsemployedtocompletethisexperiment.

Table1:InstrumentsEmployed:

Instruments Model# Company

WorkingElectrode N/A BAS

ReferenceElectrode N/A BAS

AuxiliaryElectrode N/A BAS

Potentiostat EpsilonEC-USB BAS

StirringUnit EpsilonRPM250 BAS

Table2includesallavailableinformationregardingthechemicalreagentsemployedtocompleteexperimentIII.

Table2:ReagentsEmployed:

Chemical Supplier LotNumber MolecularWeight ExpirationDate

PotassiumFerricyanide Spectrum OV0185 329.24g/mol N/A

PotassiumNitrate Spectrum QH2542 101.10g/mol N/A

AmountofReagentsUsed:

Calculation#1:DeterminingamountofKNO3neededtoprepare1Lof1Msolution.

TheamountofK3Fe(CN)6ingramstoprepare10mMsolutionwasdeterminedsimilarly.

Table3belowincludestheamountofeachreagentusedingrams.Table3:Amountofreagentsused:

Reagent AmountUsed

PotassiumNitrate 101.10gKNO3

PotassiumFerricyanide 0.814gK3Fe(CN)6

UnknownPotassiumNitrate PreparedbyTA

PreparationofStandards:

Calculation2:DeterminingthevolumeofPotassiumFerricyanideneededtomakestocksolution

8(250)=9.89(x)=202.2mLK3Fe(CN)6neededtopreparea~8mMSolution

250mL(x)=9.89mM(200)=7.912mM

Allserialdilutionswereconductedinasimilarmanner.

Table4belowincludesallinformationavailableonthepreparationofthesolutionsusedinexperiment3.Table4:Preparationofsolution

Concentrations(mM) VolumeofK3Fe(CN)6(mL) VolumeofKNO3(mL)

2 100mL 49.64mL

4 100mL 66.5mL

6 250mL 189.59mL

8 202.2mL 250mL

ResultsandDiscussion:

Table5:HalfCellpotentialofDPVEp(mV) DPVHalfCell

Potential(mV)HDVHalfCellPotential(mV)

CVHalfCellPotential(mV)

LiteratureValueCVHalfCell(mV)

256

128 161 234 225

Usingequation2andtheEpfromthe4mMsamplethehalf-cellpotentialwasfoundtobe128mV.ThevaluecomparesfavorablytothevaluefoundinHDVandCV,whichwere161mVand234mV,respectively.Figure1:DPVofFerricyanideatdifferingconcentrations.

AsdemonstratedinFigure1,theheightofthepeakisproportionaltotheconcentrationoftheelectroactivecompound.Figure2:DPVofUnknownsampleofFerricyanide

0.00E+00

1.00E-05

2.00E-05

3.00E-05

4.00E-05

5.00E-05

6.00E-05

-4.00E-01 -2.00E-01 0.00E+00 2.00E-01 4.00E-01 6.00E-01 8.00E-01 1.00E+00

Curren

t(A)

Potential(mV)

DPVofFerricyanide

2mM

4mM

6mM

8mm

10mM

Figure2showstheresultingvoltammogramoftheunknownsamplewhichwaspreparedbytheTA.

Figure3:CalibrationofDPV

Table4:Concentrationvs.CurrentConcentration Current

2 2.20E-05

0.00E+00

5.00E-06

1.00E-05

1.50E-05

2.00E-05

2.50E-05

-0.4 -0.2 0 0.2 0.4 0.6 0.8 1

Curren

t(A)

Potential(mV)

DPVofUnknownFerricyanide

y=4E-06x+9E-06R²=0.91925

0

0.00001

0.00002

0.00003

0.00004

0.00005

0.00006

0 2 4 6 8 10 12

Curren

t(A)

Concentration(mM)

CalibrationplotofDPV

4 2.21E-056 3.16E-058 4.09E-05

10 5.56E-05Table4includestheEpcurrentforeachconcentrationused.Thisdatawasusedtocreatethecalibrationplotinfigure3.Table5:ConcentrationoftheunknownEquationoftheLine Current mMy=4E-06x+9E-06 2.34E-05 3.6

Table5includestheequationoftheline,theEpoftheunknownandthecalculatedconcentrationusingtheequationandtheEpvalue.

Conclusion:

Overall,thelabprocedurewasveryenjoyable,themethodsinvolvedindoingserialdilutionarefuntocarryoutandstraightforwardonceyoubegintheprocedure.Wewereabletocarryouttheseprocedureswithminimalissues,especiallyafterhavingmoreexperiencewithitaftercompletingexperimentIandII.ThecalculationsandexplanationsarequitedifficultbuthavegotteneasierwhencomparedtoexperimentsIandII,asaresomeofthetheorypieces,withouthavingasolidbackgroundinelectrochemistry,andalsonothavingourelectrochemistrylecturesyet.Hopefullythisproblemcanbealleviatedinthefuturebyexpandingthequantitativelaboradjustingclasssize.

References:

1.Experiment1:CyclicVoltammetryofFerricyanide,LaboratoryHandout,

Chemistry2410L,FallSemester2016

2.Harris,DanielC.2010.QuantitativeChemicalAnalysis.8thed.Chapter16: ElectrochemicalTechniques.W.H.Freeman,2010. 3.Skoog,D.A.,Holler,F.J.,Neiman,T.A.,Voltammetry; in

PrinciplesofInstrumentalAnalysis,SaundersCollegePublishingCompany, Chapter25,1998.4.Wang,J.,PracticalConsiderations;AnalyticalElectrochemistry,JohnWileyandSons, Chapter4,2006.

CHEM3080LabSafety,procedure,andexecutionsheet.BackgroundInfo:

CharlesRiley8/2/16Chem3080;9a-11:50aSeparationandQuantificationoftheComponentsofaReactionMixturesbyGasChromatography(GC)

PhysicalInfo:

ChemicalsUsed:

Compound

SulfuricAcid AmmoniumChloride 1-Butanol

Structure:

MolecularWeight:

98.079g/mol 53.491g/mol 74.1216g/mol

Density:

1.84g/mL 1.53g/cm^3 0.81g/mL

HealthHaz

Corrosiveifincontactwithskinandeyes.Maycausetissuedamage,especiallyifincontact

Slightlyhazardousincaseofskincontact.Irritantifincontactwithskin.

Veryhazardousincaseofskincontact.Maycauseinflammationoftheeyes.

ards:

withmucousmembranes.

Quantity:

1mL

0.0187mol(1mL*1.84g/mL/98.079g/mol)

0.5g

0.0093mol(0.5g*53.491g/mol)

0.5mL

0.0055mol(0.5mL*0.81g/mL/74.1216g/mol)

Discussion:i.)EquimolarMixture:[Butanolusedasstandardforcalculations]

IntegralRRCalc.

Sample:IntegralCorrectedCalc.

MolarRatio

Chlorobut.32.141.166(32.14/27.56)

61.8853.07(61.88/1.166)

53.07:

Butanol27.561(27.56/27.56)

28.2928.29(28.29/1)

28.29:

DibutylEther40.301.462(40.30/27.56)

9.836.72(9.83/1.462)

6.72

ii.)LabQuestionsIftheGCmeasurementperformedonacolumnat100°Cleadstoapoorseparationoftwocompounds,explainwhyanincreaseoftheGCcolumntemperaturemightimprovetheseparation.Whymightanincreaseincolumntemperaturealsoworsentheseparationoftwocompounds?

Anincreaseinthecolumntemperaturewilldecreasetheretentiontime,whichmaymakethepeaksonaGCusingcompoundswithlongerretentiontimeslessbroadandincreaseresolution,thusleadingtoabetterseparationresult.However,anincreaseintemperaturemayworsentheseparationifthetemperatureifraisedtoohigh.Thiscouldleadtosuchasteepdecreaseinretentiontimethatcompoundsmovethroughthecolumnalmostimmediately,leadingtoonlyoneobservablepeak.Thus,makingtheseparationunsuccessful.

GreenChemistry:

WhatisthetaskofthegovernmentorganizationknownasOSHA?WhatareOSHAstandards?PleaseshowoneOSHAstandardforbenzene(acommonchemicalingasoline).

OSHAisanagencyoftheUSdepartmentoflabortaskedwithassuringworkplacesafety,ensuringhealthfulworkingconditions,andenforcingstandards.OSHAstandardsarerulesandregulationswhichemployersmustadheretoinordertoensurethesafetyandhealthofemployees.

OSHAStandardforBenzeneprovidedbelow:“1910.1028(j)(2)(i)

Theemployershallpostsignsatentrancestoregulatedareas.Thesignsshallbearthefollowinglegend:

DANGERBENZENEMAYCAUSECANCERHIGHLYFLAMMABLELIQUIDANDVAPORDONOTSMOKEWEARRESPIRATORYPROTECTIONINTHISAREAAUTHORIZEDPERSONNELONLY”

CounselingandEducationNUTR3600CulturalAnalysisofPacificIslanderPopulationPresentation

A. WhoisclassifiedasaPacificIslander?- ThosewholiveinthePacificIslands- 3classifications

o Polynesians(Hawaii,NewZealand,SamoanIslands,etc.)o Melanesia(NewGuinea,Fiji,SantaCruzIslands,etc.)o Micronesia(IslandsofKiribati,Nauru,Marianas,etc.)

B. StapleFoods- Seafood(particularlyfish)- Pork- Seaweed- Rootvegetablesandtubers- Sweetpotatoes/yams

- Tropicalfruits(pineapple,mango,banana,andpapaya)- Coconuts/Coconutmilk

C. TabooFoods- Someseculartaboosstillexist(e.g.superstitionaroundeatingmice).However,mosthave

diedout.- Somefishingrestrictionsforenvironmentalprotectionpurposes.

D. TypicalFoodPreparationandTechniques- Largelyinfluencedbythosecountriesthatclaimedcontrolofthem.

o IncludesUnitedStates,France,Germany,andBritaino e.g.FrenchinfluenceoncookingstylesonTahitiandpresenceofcornedbeefand

SpaminPacificIslanderdishes- Fishistraditionallyeatenraw,poached,orgrilled.- Coconutisbeingpeeledandeatenwholeormashedintoapastethatisdippedintowarm

coconutmilk.E. FamilyDynamics/FamilyFoodDynamics

- Communityisequivalenttofamily.Muchisshared,includingfood.o Manytimes,fishermentakewhattheyneedfromtheircatchandleavetherestfor

othercommunitymembers.- Otherfamilydynamicsincluderespectforelders,fatherfilingtheroleofheadofthefamily,

andchildrenremainingathomeuntilmarriage.F. FoodTraditions,Celebrations,Customs,andBeliefs

- Kava(pronounced"kah-vah")o nonalcoholic,mildlynarcoticceremonialbeveragemadewiththegroundrootofthe

peppershrubo passedfrompersontopersoninagroupandismeanttorepresenttocoming

togetheroftwofamilieso customaryforFijianvillagevisitorstopresentthevillageexecutiveheadwithKava

- Yaqona(pronounced"yanggona")o mildlyintoxicatingbeverageconsumedduringimportantFijioccasions,likebirths,

weddings,deaths,andthearrivalofadignitaries- Holidaysinclude

o Christianholidays,suchasEasterandChristmaso BastilleDay,aFrenchIndependenceDay,onFrench-speakingislandso July4th-celebratedasKingTaufa'ahauTupouIV'sbirthdayandanationalholiday–

inTonga- Mostcelebrationsareexpectedtoincludedfeasting,music,anddance.Musiciansplaythe

guitarandtraditionalinstrumentslikethepahu(awooddrum),ukelele,uliuli(smallgourds),ipu(largergourds),puili(splitbamboo)andTahitiandrumsmadeoutofhollowedlogs.

G. CommunicationStyles/NonverbalBehaviors- Communicationbasedonfamilyroleandhonor.

o Highvalueplacedonindirect(non-verbal)communication.§ Silenceisusedtocallattentiontoneedsanddesires.

• Bodylanguageandexpressionshelptorelaymessage.Thespeakerisexpectedtointerpretsilenceandaddressneedsaccordingly.

§ Silencealsohelpstoavoidcallingattentiontomistakesandoversightsandmaybeindicativeoffamilyrole(i.e.ifpersonisnottheheadofthefamily).

o Directcommunicationoffeelingsisdiscouraged.§ Seenasshamefulandbreaksobligationtothefamily.

o Mayhideprevioushealthcareinformationand/ordiagnosesinordertoprotectthefamilyreputation.Canbecomeabarriertoclinicalcare.

o Eyecontactisavoided§ Seenasdisrespectful,especiallytoauthority/healthcarefigures

- Etiquetteincludesthewearingofshoesinthehouse.ItisalsoconsideredrudetotouchaFijianonthehead.

NUTR3600NutritionEducationToolwithTypeIdiabeteswithVeganDiet

VeganismandDiabetesRecentresearchshowsthatavegandietcanhelpthosewithdiabetesbettermanagebloodsugarlevels.WhatisDiabetes?Diabetesmellitusisaconditionthatinhibitsthebody’sabilitytomanagesugarlevelsintheblood.Therearetwodifferenttypesofdiabetes: TypeOne TypeTwo

WhatisVeganism?Thevegandietissimilartothevegetariandietinthatitexcludesmeat.Thevegandietjusttakesitastepfurtherandexcludesallanimal-basedfoods,includingeggs,dairyproducts(likemilk,cheese,andyogurt),andmeatbroths.

HowcanveganismhelpsomeonewithTypeTwo?

Researchhasdemonstratedthatsaturatedfats-atypeoffattypicallyfoundinanimal-basedproducts-makesitmoredifficultforinsulintoremovesugarfromtheblood,leadingtohighbloodsugarlevels.Onewaytolowerthistypeoffatinthedietcanbeaccomplishedbyremovinganimal-basedproducts.Thisdecreaseinsaturatedfatintakehelpsinsulintobetterdoitsjob.

HowcanveganismhelpsomeonewithTypeOne?GlycemicIndexisthemeasureofhowhighafoodraisesbloodsugarlevelsoveraperiodoftimeaftereating.ForthosewithTypeOnediabetes,thisisaveryimportantvalue.Foodswithhigherglycemicindexraisebloodsugarlevelsfasterandcanincreasetheselevelsbeforeinsulincanhaveaneffect.Tokeepbloodglucoselevelslower,youshouldtrytoeatfoodswithalowerglycemicindextokeepblood

The body cannot produce an important hormone called insulin which is responsible for taking sugar out of the blood and storing it in the body’s cells.

A person with type one diabetes must use

insulin shots to regulate blood sugar levels

The body is still able to produce insulin, but is either not producing enough or is unable to use it correctly.

Those with type two diabetes can

manage their blood sugar levels with insulin shots or pills, or by maintaining a healthy diet and exercising.

glucoselevelsfromspiking.Thevegandietisrichwiththeselowglycemicindexfoodslikenon-starchyvegetables,fruits,andwholegrains.HowdoIgetstarted?

● Identifyfoodsinyourdietthatcontainanimal-basedproducts.Watchoutforhiddensourcesintheingredientlist-youneverknowwhereyoumightfindthem!

● Easeintoit.Aimtoremoveonemeatproductaday!

● Usemeatalternatives,suchastofuandalmondmilk.Eveneggscanbereplacedwithflaxseeds,applesauce,andhoney!

● Experimentwithprotein-pairing!Removingmeatsfromthedietremovesalotoftheproteinyouwouldotherwisebeeating.Darkleafygreenspairedwithlegumesornutsareagoodwaytomakeupforthelostprotein!

Foradditionalresearch,visit:http://www.pcrm.org/health/diabetes-resourcesFoodandNutritionNUTR1000NutrientAnalysisProject1.Compareyourpercentageofkilocaloriesfromcarbohydratetothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.Rec’d%CHO:45%-65% YourCHO%:52% a.IncorporatesmallerportionsoffoodsthataremoreCarbohydrateDense.Foodspackedwithstarch,berries,apples,andwhole-wheatfoodscouldfillthisrole.

b.Insteadofeating3largemeals(~90carbs/meal),eat6smallermealsofabout45-50carbs.Thisamountwouldmakeportioncontroleasier,andcouldhelpcontrolcravingsforhighcarbjunkfoods.c.Asanalternativetothe6meals/daymentionedinb.,continueeating3mealsat90carbs/mealbutincorporate3snacksataround15-30carbspersnack.Thisagainwouldmakeportioncontroleasierandcontrol“highcarbcravings”.

2.Compareyourpercentageofkilocaloriesfromproteintothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.

Rec’d%PRO:10%-35% YourPRO%:19%a.SwitchthebulkofmealsfromMeatbasedtoincludemoreDarkGreenswithMeatasa“sidedish”.b.LimitintakeofCheeses,beans,lentils,nutsandseedstolimitnon-animalsourcesofprotein.c.EliminateAnimalsourcesofproteinduringmealtime,andreplaceitwithamoderateamountofnon-animalsources,asitmaybeeasiertocontrolportionsizesthisway.

3.Compareyourpercentageofkilocaloriesfromfattothatoftherecommendedrange.Site3specificfoodhabitsthatshouldbechangedormaintained.

Rec’d%FAT:20%-35% YourFAT%:30% a.Chooseleanercutsofmeatwhencooking,tolimittheintakeofexcessfatfromlessleancuts.b.Limit“snack”and“junk”foodsthatcanbepackedwithfatlikepastryfoodsandpotatoeschips.c.Completelyavoidfastfood,oratleastchooselessfattyoptionsatsuchplaces.Ex.ChooseasaladoverfattyhamburgersandappleslicesinsteadofFrenchfries.

4.Compareyourpercentageofeachtypeoffattothatoftherecommendedranges.SiteONEspecificfoodhabitthatshouldbechangedormaintainedFOREACHTYPEOFFAT.

Rec’d%saturatedfat: <7% Yoursat.fat%:10%

Rec’d%monounsaturatedfat:10%-15%Yourmonounsat.fat%:10% Rec’d%polyunsaturatedfat: 10% Yourpolyunsat.fat%:6%a.Limitintakeofmeatslikesausage,bacon,etc.asthewaytheyarecooked/thethingstheyarecookedincanaddunnecessaryamountsofgrease(SaturatedFats).b.TrytoincorporateFishintothediettoencourageintakeofOmega3FattyAcidsandmonounsaturatedfats.c.Cookwithoilshighinpolyunsaturatedfats.Oilsincluding:Soybean,Corn,andSunfloweroil.

5.Compareyourmilligramsofdietarycholesterolyoutookintothatoftherecommendedranges.Site3specificfoodhabitsthatshouldbechangedormaintained.Rec’d:300mg/day Yours:164.88mga.Continuetolimit“organmeats”inthediet.Theycancontainhighamountsofdietarycholesterol.b.Eatoneegg/daytomakeupforthedifferenceinmyrecommendedamountandactualintake.c.Limitallintakeofshellfishastheycancontributelargeamountsofdietarycholesterol.6.Comparetotalgramsofdietaryfiberyoutookintothatoftherecommendedranges.Site3specificfoodhabitswhichshouldbechangedormaintained.Rec’d:38g Yours:12.31ga.SwitchfromWhiteBreadtoWheatbread.Wholegrainscontainhigheramountsoffiberthanrefinedgrains.b.Keepskinsonfruits,berries,andvegetables.Skinsarehighinfiber.c.Increaseamountsofnuts,beans,andpopcorninsnacks.Allarefiberdenseandeasytoworkintothediet.7.Compareyourmilligramsofdietarysodiumyoutookintothatoftherecommendedranges.Site3specificfoodhabitswhichshouldbechangedormaintained.Rec’d:1500mg Yours:3105.56mga.Eatlesssaltysnackslikepotatoeschips,saltedpeanuts,andsaltedpretzels.b.LimitintakeofSoda,1servingcancontainaround50mgofsodium,whichcanaddupquicklyinpeoplethat

consumelargequantitiesinaday.c.Cookfreshfoods,asopposedtocookingcannedfoods.Cannedfoodsareveryhighinsodiumtopreserve

thefood.8.Listallthevitaminsthatfellbelow75%oftheRDA/DRIinyouraveragedanalysis.ThenforEACHvitamin,listthreerichsources.(Useseparatepieceofpaperifneeded)Folate– Beets,BeefLiver,PintoBeansVitaminC- GrapeFruit,Peppers(Red&Green),StrawberriesVitaminD- FortifiedMilk,Sardines,FortifiedCerealVitaminA– Carrots,SweetPotatoes,CookedSpinachVitaminE- SunflowerSeeds,CanolaOil,WheatGerm

9.Listallthemineralsthatfellbelow75%oftheRDA/DRIinyouraveragedanalysis.ThenforEACHmineral,listthreerichsources.(Useseparatepieceofpaperifneeded)Magnesium–Spinach,BranCereal,BlackBeansPotassium– BakedPotatoes,OrangeJuice,BananasZinc– Oysters,Shrimp,BeefSteak

10.Examineyourthree-dayintakesanddetermineifyouralcoholintakewasmoderate.Discusssomehealthconsequencesofexcessiveintakeand2strategiesyoucouldimplementtomoderateorabstainfromalcoholingestion.Answerthisquestionregardlessofyouralcoholintake.AlthoughIdidnotconsumealcoholinmy3-dayrecordingperiod,thenegativeconsequencesofexcessiveintakeofalcoholincludeLiverDamage,Cardiovasculardisorders,certaincancers,andsomementalhealthissues.Morespecifically,AlcoholcancauseLiverFailure,depression,andanemia.Strategiesthatcouldberecruitedtomoderateorcompletelyabstainfromalcoholuseincludeurgecontrolwithactivitiessuchasexercise,outdooractivities,andotherconstructive“distractions”.Anotherstrategythatmightbeeffectiveistoavoidareaswherepeerpressure/theenvironmentisconducivetodrinkingalcoholinexcess,areaslikebars,parties,etc.

11.Compareyourestimatedenergyrequirementstotheaveragekcalsyoutookin.Basedonthisdata,indicatebelowifyouareinpositive,negative,or“maintenance”energybalance.Basedonthisdata,howfastwouldyougainorloseweightifyoucontinuedthistrend?Refertopage340ofupdatedtexttohelpanswerthisquestion.a.Youraverageestimatedenergyrequirement:2176.0kcalb.Youraveragekcalintake:1592.55kcalc.Basedontheabovedata,Iamin:(Circletheappropriatechoiceforyou)

POSITIVEENERGYBALANCENEGATIVEENERGYBALANCE“BALANCED”ENERGYBALANCE

d.Atthisrate,Iwouldgainorlose,ormaintainatarateof1.17poundsperweek.

NUTR2000ReflectiveJournal/InterviewwithElderlyPatientontheImportanceofNutritionCare Forthepurposeofthisassignment,Iintervieweda66-year-old,caucasian,female.Thesubjectismarried,livingathomewithherhusband.Shehasbeenretiredforfewerthan10years,anddoesnotholdacollegedegree. Whenconductingthenutritionscreeninginitiative,thesubjectwasfoundtohaveascoreof5,indicatingmoderatenutritionrisk.Thesubjectindicatedthatshehadanillness,whichaffectedherdietmarginally(typetwodiabetes),takes3ormoreprescribedmedications,andisnotalwaysablephysicallytoshopforherself.However,thesubjectindicatedthatherhusbanddoestheshopping,negatingtheinabilitytoshopforherself,andsomeofthemedicationssheisprescribedareprescribedinconjunctionwithherdiet.Withthatinmind,Ibelievethatthissubjectisatalowtomoderatenutritionalrisk.

Inmyopinion,Ibelievethatthissubject’sintakeisappropriateforherdiseasestate.Itseemsthatshefollowsherprescribedmealplanveryclosely.Further,sheandherhusbandseemtotakeproactivestepstoeathealthyforthesakeofherhealthcare.Physically,thepatientsseemextremelyhealthyasidefromproblems,whicharosefrommultiplehipreplacementsurgeries.Itseemsthatthesesurgerieshaveledtoaninabilitytoexerciseattributingtoherdiseasestate,andnotfrompoornutrition.Duetothispositiveattitude,adherencetodietaryrecommendations,andalifetimeofhealthyeating,Idonotseehernutritionalriskchanginginthenextsixmonths. Thissubjectwasverynon-typicalinherapproachtonutritionandlifeingeneral.Whilemanyinheragegroupmayhavelostenthusiasmintheirhealthcareduetothe“thebestisbehindme”effectthatmanyelderlyexhibit,sheseemstobecontinuingalifelongpositiveapproachtohealth.Ibelievethiscanmostclearlybeseenwhenlookingatthehealthofherhair,nails,andskin.AllseemtobeveryhealthydespiteherclassificationasoverweightbasedonBMI.Ibelievethatifwecouldgivetheelderlyapositiveoutlookonhealth,theycouldachievebetteroutcomes.Further,weshouldencouragepropernutritionasnormal,andnotsomethingthatisjust“new-fangled”.Weshouldinvokeimagesoftheway“peopleusedtoeat”.Encouragingpeopletoeatfreshfruitsandvegetables,whilelimitingintakeoffriedfoods,foodswithaddedsugar,andhighsodiumfoods.Thisisadauntingtaskhowever,aseconomically,thisisnotrealisticforallelderlypeople.“Healthier”foodstypicallycostmuchmorethanfriedfoods,makingthemhardertoattain,especiallyforelderlylivingonfixedincome. Iwasverygladtoconductthisproject,asitgavemenewinsightintoelderlynutrition.Iwasundertheimpressionthatmostelderlypeoplecaredlittleaboutclinicalnutrition.I’mgladtosaythatmysubjectprovedmewrong.Herpositiveattitude,andgeneralcareforhermealplangavemenewhopeforfuturenutritiontherapyintheolderpopulation.NotesFemale,66yearsofage,Caucasian,Married,Home,HighSchoolEducation,RetiredWhatfoodsdidyoueatregularlywhenyouwereyounger? “Well,livingonafarmnearAmesville,weatemainlywhatwebroughtin fromthefarm.Potatoes,beans,breadandwheatfromthefield,freshmilk fromthedairycows,fresheggsfromourchickens,andwealwayshadfresh meatfromthecowsweraisedforslaughtereveryyear.”Howhasthatchangedasyou’veaged? “I’vehadtypetwodiabetesforafewyearsnow,andItrytosticktowhatmy doctorrecommends.Isticktolowercarbfoods,Idrinkalotofwater,andI eatalotofgreensandvegetables.Whatfoodswarrantedspecialoccasionswhenyouwereyoung? “Well,weateaboutthesamewhenwewerehomefortheholidays,butwhen wewenttotownwemightstopandgetrestaurantfoods,Frenchfriesand cokesandsuch.Wedidn’teatouttoomuchsoitwasprettyspecialwhenwe did.”Arethereanyfoodsthatyouparticularlylikeordislike?Eithernoworinyourchildhood? “I’vealwayslovedvegetables.Tomatoeshavealwaysbeenafavoriteofmine. Icaneatthoseeveryday!I’mnotsureI’veeverfoundafoodIwouldn’teatin particular,IguessIdon’treallycareforsweetstoomuch.”

Haveyourfoodpreferenceschangedovertheyears? “Notparticularly.I’vealwayslovedfruitsandvegetables,eventothisday.”Whodoesthegroceryshopping?Wheredotheyshop? “Thatwouldbemyhusband,Idon’tgetouttoomuchbecauseofmyhip surgery,sohedoesmostofthat.Heusuallyjustgoesdowntheroadto Kroger.” Whoplansthemeal? “I’vegotaprettystrictdietplanfrommydoctor,andbothmyhusbandandI trytofollowitprettyclosely.Iguessyoucouldsaythatmydoctorplansmy meals,wejustcookthem.”Whopreparesthemajorityoftheirmeals?Areothersinvolved? “I’vealwayslovedtocook,and”sodoesmyhusband,sowetendtoshare mealpreparationtime.Whenthekidscometothehousetheyliketohelpout atwell.”DoyoureceiveSeniorFarmer’sMarketvouchers,Meals-on-Wheels,orattendcongregatemealsites? “Iknowwecouldgetthemifwewantedthem,butwehaven’tneededtouse them.We’vebeenblessedwiththat.” Arethereandcultural,ethnic,orregionalinfluencesonyourdiet? “Nonethatcometomind,IeatclosetohowI’vealwayseaten.”Doyouhaveanygoodallergies? “None”Doyoumodifyyourdietinanywaytoprevent,treat,ormanageanychronicdiseases? “Icontrolmyportions,takemymedication,andlimitmycarbintaketo managemytypetwodiabetes,asidefromthatno.”Areyoucurrentlytakingmedications?Approximatelyhowmanyperday?Arethereanydrug/nutrientinteractions?Doesthisconcernyou? “I’vegotaprettyextensivelist.Inaday,Iprobablytakesomewherearound 6-7differentmedications,somefordiabetes,someforpain.Mydoctorshave goneovermydietplanandmedicationslistsmanytimesandthey’venevertoldmethattheywereconcernedwithinteractions,soIguessI’mnot either.”Doyoutakeanyvitaminormineralsupplements?Herbal?Aretheynecessary? “Ijusttakeamultivitaminlikemydoctorrecommended.Noneotherthanthat.IfmydoctortoldmethatIneedtotakethem,thenIprobablyneedtotakethem.Iseenoneednottotakethem.“Doyouthinknutritionisimportanttotreatingchronicdiseases?Howimportantdoyouthinknutritionistocontrollingyourdiabetes? “Absolutelynecessary.Yourbodycan’tfightbackifitdoesn’thavetheright fuel.Asformydiabetes,Iknowthatnutritionisthebiggestpartofmytreatmentasidefrommymedications.Iwouldn’tbeanywherenearwhere mytreatmentisnowwithoutpropernutrition.“Havetherebeenanybarrierstoeatinghealthy? “Notreally.LikeIsaid,I’vealwayseatenhealthy,soit’sbeeneasytofollowmydietandtoeathealthy.”

PhysicalObservation a.VisuallyOverweight. b.Musclewastinginthelegsduetomultiplehipreplacementswithimproperphysicalactivitypost-op. c.Skin-healthy,Nails–healthy,Hair–healthy,Mouth–healthy d.FullNaturalTeeth e.Nodifficultywithfinemotorskills,motorskillsinthelegsareimpaired.NUTR2200Areviewofnutrientsupplementationintheclinicaltreatmentofdiabetesmellitus.

Diabetesaffectsnearly30millionAmericantoday.Itisaclassofmetabolicandendocrine

diseasescategorizedbyimpairedglucosemetabolism.TypeIdiabetesisadiseaseoftheendocrine

system,involvingthedestructionofthepancreaticbetacells,whichresultsintheinabilityofthebodyto

produceinsulin.TypeIIdiabetesandgestationaldiabetesarebothmetabolicdisordersinwhichthe

bodycellsbecomeresistanttoinsulin.

TypeIdiabetes,historicallyknownasjuvenilediabetes,makesuplessthan10%ofallcasesof

diabetesworldwide.TypeImorecommonlyaffectschildrenandadolescence,withadultonsetbeing

muchrarer.Thistypeofdiabetesresultsfromthedestructionofbetaisletcellsontheendocrineportion

ofthepancreas.Itisthoughtthatthisoccursfromaculminationofmultiplefactors.Thefirstofthese

beinggeneticdispositionthatisthentriggeredbyanenvironmentalfactor,mostlikelyavirus.

TypeIIdiabetes;historicallyknowasadultonsetdiabetes,makesuptheremaining90%ofall

diabetescasesworldwide.TypeIIisametabolicdisorderinwhichcellsbecomeresistanttoinsulin,

disallowingadequatetransportofglucoseintothecell.Thiscausesbloodglucoselevelstorise,andif

nottreatedcanresultincomplicationssuchasretinopathy,nephropathy,andneuropathy.TypeIIcan

betreated,byinlarge,withexercise,healthydiet,andlifestylechanges.Ifthesemethodsdonotyield

intendedresults,insulinandothermedications,whichcontrolsatiety,hunger,andinsulinusage,maybe

addedaswell.

Insulinisahormoneproducedandsecretedbypancreaticbetacells.Thishormoneisthekeyto

glucosemetabolisminthebody.Afterglucoseisconsumed,itistransferredtothebloodstreamfor

circulationtocellsforenergy.Glucosealonecannotcrossthecellmembranewithoutfacilitation

throughGLUT-4(GlucoseTransporterType4),aproteinthatallowsfortransportofglucoseintothecell.

GLUT-4isregulatedbyinsulin.Withoutinsulin,glucosewouldnotbeavailabletobodycellsforenergy.

Becauseofthis,insulinistheprimarytreatmentoptionforuseintypeIdiabetics.Itisdeliveredtypically

viasyringe,flexpen,orpumpinfusionsystems.

AlthoughinsulinisabsolutelyessentialinthetreatmentoftypeIdiabetes,andalsohighly

effectiveinthetreatmentoftypeII,patientsandphysiciansmayseektreatmentsinadditiontoinsulin

toachievehigherlevelsofbloodglucosecontrol.Tothatend,researchershavebeentestingthe

feasibilityofmanynutritivesupplementsandhowtheymayimproveglucosecontrolsincethediscovery

ofinsulin.Amongtheseoptionsincludevitamin,mineral,andmacronutrientadditives.

AlphaLipoicAcid(LA),alsoknownasthiocticacid,isadi-thiolcontainingacidknowntoworkas

anantioxidantinthebody.8Asearlyas1970,LAwasfoundtoinhibittheincreaseinacetyl-CoAand

citrateconcentrationinducedbyoctanoateduringglycolysis.3,13Further,LAwasdiscoveredtoincrease

glucoseuptake,phosphofructokinaseactivity,andincreasetheoverallspeedofglycolysis.3,13Thisisa

step-wiseeffect;normally,acetyl-CoAisinhibitedbyoctanoicacid,however,LAisverysimilarin

structureandalsodemonstratestheabilitytoinhibitrisinglevelsofacetyl-CoA.acetyl-CoAbeinga

precursortocitrate,wheninhibited,alsoinhibitstheriseincitrateconcentration.3,13Citrateisaknown

inhibitorofphosphofructokinase,anenzymewhichpreparesglucoseforentryintoglycolysis.3,13With

thecitrateconcentrationinthecellheldstablebythisinhibitionpathway,glucosecancontinuouslybe

preparedforandentertheglycolysispathway.3,13Thisallowsforanincreaseinglucoseuptakefromthe

bloodstream,leadingtobettercontrolofbloodglucoselevels.3,13

Carnitine(L-carnitine)isabiologicalcompound,whichprimarilytransportslongchainacyl

groupsfoundonfattyacidsintothematrixofthemitochondria,tobebrokendownintoacetyl-CoA

throughbeta-oxidation.Carnitinewasbelievedtobeviableinuseindiabeticpatientsduetoitsrolein

theformationofacetyl-CoA,whichdrivesglucosemetabolismforward.Itwasdemonstratedin1999

thatcontinuousinfusionofcarnitineintobothdiabeticandnon-diabeticpatientsalikeincreasedwhole

bodyglucoseuptake.15Inthediabeticpatientsspecifically,insulinsensitivitywasshowntoincrease,and

glucosetakenupwaspromptlyutilized.15Itwasalsofoundthatplasmalactatelevelsweresignificantly

reducedinthepatientsreceivingcarnitineinfusions.15Thisleadtheresearcherstobelievethatcarnitine

mayservearoleintheactivationofthepyruvatedehydrogenasecomplex,whoseactivityisinhibitedin

insulinresistantindividuals.

Chromiumisatracemineral,meaningitisneededinsmallquantitiesinthebody.However,

chromium’spotentialroleinregulatingbloodglucoselevelswasnotdiscovereduntilthelate50’s,by

SchwarzandMertz.4Thiseffectwasfurtherdemonstratedinhospitalizedpatientsinthe1970’s,where

itwasfoundthatChromiumsupplementationreversedglucoseintolerance.1,4Despitethis,ameta-

analysisconductedin2002,whichevaluated20studiesinvolvingthesupplementationofchromiumin

thosewithandwithoutdiabetes.2Thismeta-analysisfoundthatchromiumsupplementationdidnot

impactbloodglucosecontrolineithertheparticipantswithorwithoutdiabetes.2

CoenzymeQ10,alsoknownasubiquinone,isavitaminlikesubstancefoundprimarilyinthe

mitochondria.ItwaspreviouslythoughtthatCoenzymeQ10mightreduceoxidativestresscauseby

diabetes.10However,ina2002studythiswasnotfoundtobethecase.Seventy-foursubjectswere

given100mgofCoQ10orally,twiceperdayfor12weeks.ItwasfoundthatCoQ10didimproveglycemic

controlandbloodpressure;however,noproofofpreventionofoxidativedamagewasdemonstrated.10

ResearchersconcludedthatmoreresearchisneededtofullyunderstandtheeffectsofCoQ10in

patientswithdiabetes.10

Magnesium,amacromineral,isneededinrelativelylargequantitiesinthebody.Magnesiumis

knowntobeacofactorandprecursortomorethan300enzymes.Meaningthatmagnesiumishighly

involvedinmanybiochemicalpathwaysthroughoutthebody,includingbloodglucosecontrol,

specificallyinglycolysis.9Mg2+isknowntoregulatethefunctionsofhexokinaseand

phosphofructokinase,twoofthemostimportantenzymesinglycolysis.9Tothatend,Harvard’sschoolof

publichealthinvestigatedtheeffectofmagnesiumintakeonbloodglucosecontrolin2004.Their

researchfollowed127,932patientswithnohistoryofdiabetes,cardiovasculardisease,orcanceratthe

timeofbaselinetesting.Thehighestandlowestquintileoftotaldietaryintakeofmagnesiumwas

compared.Itwasfoundthatthoseinthehighestquintileofmagnesiumintakehadasignificantlylower

riskofdevelopingtypeIIdiabetes.Theresearcherswentontorecommenddietshighinmagnesium,

specificallydietshighinwholegrains,nuts,andleafygreenvegetables.

Zinc,likechromiumisatracemineral,thoughttohavearoleinbloodglucosecontrol.5Thefirst

researchintowhetherornotzinccouldlowerbloodglucoselevelscamein2005,whenitwas

administeredtotypeIpatients.ZincwasadministeredorallyatDRIlevels,dailyfor4months.Attheend

ofthe4-monthperiod,HemoglobinA1clevelswerefoundtohaveincreasedduringthestudy.Itwas

concludedthatmoreresearchneededtobecarriedouttodeterminewhetherZincisasuitable

supplementforuseinpatientswithtypeIdiabetes.6MoreresearchintoZinc’seffectswascarriedout

post2005,andameta-analysisof25studieswassubmittedtotheJournalofDiabetologyandMetabolic

Syndromein2012.11Themeta-analysispooleddatafromall25studiesandfoundsignificantreduction

infastingbloodglucoselevels,HemoglobinA1clevels,andLowDensityLipoproteinlevels,

demonstrationthatzincdoeshasabeneficiallyeffectinpatientswithdiabetes,andthatpatientswith

diabetesdidtendtohavelowerplasmazinclevelsthanhealthypatients.11However,theresearchers

failedtodeducetheexactbiologicalmechanismsresponsiblefortheseresults.11Oneexplanationfor

Zinc’seffectonbloodsugarisitsroleinthetransformationofproinsulin,theprecursorforinsulin,to

insulin.Inthismechanism,zincionscombinewithproinsulintoformazinccontaininghexamer,whichis

readilyconvertedtoaninsulinhexamer,whichcanthenbereadilyconvertedintostandardinsulin.7This

isdemonstratedinNPHandregularexogenousinsulins,whichareknowntocontainzincions.7

Manyothernutrientshavebeenstudiedtodeterminetheireffectondiabetestreatments.

Therehasbeenvaryingdegreeofsuccessinthisresearch,andmuchofwhatwasdiscoveredisstill

highlycontroversialandmisunderstood.Themosthighlyresearchedoftheseincludebiotin,carnosine,

dehydroepiandrosterone,omega-3andomega-6fattyacids,andfiber.Thepreliminaryfindingsare

outlinedhereinlessdetail,andmuchofthisresearchisstillforthcoming.Firstly,biotin,whichisa

water-solublevitamin,wasfoundtoincreaseinsulinsensitivity,andinturnbloodglucoselevels,when

administeredinconjunctionwithchromium.However,biotinadministeredintheabsenceofchromium

wasfoundtohavelittleeffectonbloodglucoselevels.Anothernutrientfoundtoeffectinsulin

sensitivityiscarnosine.Inpreliminaryresearch,carnosinecontentinhumanskeletalmusclewasfound

tohaveacorrelationtoinsulinresistance.

Alessresearchednutrient,dehydroepiandrosterone,isalsothoughttoeffectinsulinsensitivity.Other

nutrientsthoughttobeusefulintreatmentindiabetesmellitusincludevitaminB3andC,Omega-3and

Omega-6,andflavonoids,allofwhicharethoughttohavebeneficialeffectsasantioxidantsand/oranti-

inflammatoryagents,leadingtohigherinsulinsensitivityandbetterbloodglucosecontrol.

Inconclusion,therehasbeenmuchresearchonmanydifferentnutritivesupplements.Fewhave

hadasubstantialamountofresearchandhaveprovenresultsintreatingdiabetesmellitus;despitethis,

theexactmechanismsarenotunderstoodatthistime,andmoreresearchisneeded.Inothermore

preliminaryresearch,othernutrientshavebeenfoundtohaveminimalbenefitsinthetreatmentof

diabetesmellitus.

REFERENCES

1“AScientificReview:TheRoleofChromiuminInsulinResistance.”The DiabetesEducatorSuppl(2004):2–14.2Althuis,MichelleD.,NicoleE.Jordan,ElizabethA.Ludington,andJanetT. Wittes.“GlucoseandInsulinResponsestoDietaryChromium Supplements:AMeta-Analysis.”TheAmericanJournalofClinicalNutrition 76,no.1(July2002):148–55.

3Burkart,V.,T.Koike,H.H.Brenner,Y.Imai,andH.Kolb.“DihydrolipoicAcid ProtectsPancreaticIsletCellsfromInflammatoryAttack.”Agentsand Actions38,no.1–2(January1993):60–65.

4Cefalu,WilliamT.,andFrankB.Hu.“RoleofChromiuminHumanHealthand inDiabetes.”DiabetesCare27,no.11(November1,2004):2741–51.doi:10.2337/diacare.27.11.2741.

5Chausmer,A.B.“Zinc,InsulinandDiabetes.”JournaloftheAmerican CollegeofNutrition17,no.2(April1998):109–15.

6deSena,KarineCavalcantiMauricio,RicardoFernandoArrais,Mariadas GraçasAlmeida,DinaMariadeAraújo,MirzaMedeirosdosSantos, VanessaTeixeiradeLima,andLuciadeFãtimaCamposPedrosa. “EffectsofZincSupplementationinPatientswithType1Diabetes.” BiologicalTraceElementResearch105,no.1–3(2005):1–9.

7Emdin,S.O.,G.G.Dodson,J.M.Cutfield,andS.M.Cutfield.“RoleofZincin InsulinBiosynthesis.SomePossibleZinc-InsulinInteractionsinthe PancreaticB-Cell.”Diabetologia19,no.3(September1980):174–82.

8Faust,A.,V.Burkart,H.Ulrich,C.H.Weischer,andH.Kolb.“EffectofLipoic AcidonCyclophosphamide-InducedDiabetesandInsulitisinNon-Obese DiabeticMice.”InternationalJournalofImmunopharmacology16,no.1(January1994):61–66.

9Garfinkel,L.,andD.Garfinkel.“MagnesiumRegulationoftheGlycolytic PathwayandtheEnzymesInvolved.”Magnesium4,no.2–3(1985):60– 72.

10Hodgson,J.M.,G.F.Watts,D.A.Playford,V.Burke,andK.D.Croft. “CoenzymeQ10ImprovesBloodPressureandGlycaemicControl:A ControlledTrialinSubjectswithType2Diabetes.”EuropeanJournalofClinicalNutrition56,no.11(November2002):1137–42. doi:10.1038/sj.ejcn.1601464.

11Jayawardena,R.,P.Ranasinghe,P.Galappatthy,RldkMalkanthi,G.R. Constantine,andP.Katulanda.“EffectsofZincSupplementationonDiabetesMellitus:ASystematicReviewand

Meta-Analysis.”Diabetology &MetabolicSyndrome4,no.1(April19,2012):13.doi:10.1186/1758- 5996-4-13.

12Kelleher,ShannonL.,NicholasH.McCormick,VanessaVelasquez,andVeronicaLopez.“ZincinSpecializedSecretoryTissues:Rolesinthe Pancreas,Prostate,andMammaryGland.”AdvancesinNutrition:An InternationalReviewJournal2,no.2(March1,2011):101–11. doi:10.3945/an.110.000232.

13Lopez-Ridaura,Ruy,WalterC.Willett,EricB.Rimm,SiminLiu,MeirJ. Stampfer,JoAnnE.Manson,andFrankB.Hu.“MagnesiumIntakeand RiskofType2DiabetesinMenandWomen.”DiabetesCare27,no.1 (January1,2004):134–40.doi:10.2337/diacare.27.1.134.

14Mertz,Walter,andKlausSchwarz.“RelationofGlucoseToleranceFactorto ImpairedIntravenousGlucoseToleranceofRatsonStockDiets.” AmericanJournalofPhysiology--LegacyContent196,no.3(February 28,1959):614–18.

15Mingrone,G.,A.V.Greco,E.Capristo,G.Benedetti,A.Giancaterini,A.De Gaetano,andG.Gasbarrini.“L-CarnitineImprovesGlucoseDisposalin Type2DiabeticPatients.”JournaloftheAmericanCollegeofNutrition18,no.1(February1999):77–82.16Singh,HariP.P.,andR.H.Bowman.“EffectofDL-α-LipoicAcidontheCitrateConcentrationandPhosphofructokinaseActivityofPerfused Heartsfrom NormalandDiabeticRats.”Biochemicaland Biophysical Research Communications41,no.3(November9,1970):555–61.sdoi:10.1016/0006-291X(70)90048-3.

NUTR2220Areviewofthefeasibilityofzincandmagnesiumsupplementationinproductsforuseintypeonediabetestreatment

AREVIEWOFTHEFEASIBILITYOFZINCANDMAGNESIUMSUPPLEMENTATIONINPRODUCTSFORUSEIN

TYPEONEDIABETESTREATMENT

CharlesRiley

NUTR2220

4/14/16

INTRODUCTION

Diabetesaffectsnearly30millionAmericanstoday.Itisaclassofmetabolicandendocrine

diseasescategorizedbyimpairedglucosemetabolism.TypeIdiabetesisadiseaseoftheendocrine

system,involvingthedestructionofthepancreaticbetacells,whichresultsintheinabilityofthebodyto

produceinsulin.TypeIIdiabetesandgestationaldiabetesarebothmetabolicdisordersinwhichthe

bodycellsbecomeresistanttoinsulin.

TypeIdiabetes,historicallyknownasjuvenilediabetes,makesuplessthan10%ofallcasesof

diabetesworldwide.TypeImorecommonlyaffectschildrenandadolescence,withadultonsetbeing

muchrarer.Thistypeofdiabetesresultsfromthedestructionofbetaisletcellsontheendocrineportion

ofthepancreas,andtheresultinginabilityofthepancreastoproducethehormoneinsulin.Itisthought

thatthisoccursfromaculminationofmultiplefactors.Thefirstofthesebeinggeneticdispositionthatis

thentriggeredbyanenvironmentalfactor,mostlikelyavirus.

Insulinisahormoneproducedandsecretedbypancreaticbetacells.Thishormoneisthekeyto

glucosemetabolisminthebody.Afterglucoseisconsumed,itistransferredtothebloodstreamfor

circulationtocellsforenergy.Glucosealonecannotcrossthecellmembranewithoutfacilitation

throughGLUT-4(GlucoseTransporterType4),aproteinthatallowsfortransportofglucoseintothecell.

GLUT-4isregulatedbyinsulin.Withoutinsulin,glucosewouldnotbeavailabletobodycellsforenergy.

Becauseofthis,insulinistheprimarytreatmentoptionforuseintypeIdiabetics.Itisdeliveredtypically

viasyringe,flexpen,orpumpinfusionsystems.

AlthoughinsulinisabsolutelyessentialinthetreatmentoftypeIdiabetes,andalsohighly

effectiveinthetreatmentoftypeII,patientsandphysiciansmayseektreatmentsinadditiontoinsulin

toachievehigherlevelsofbloodglucosecontrol.Tothatend,researchershavebeentestingthe

feasibilityofmanynutritivesupplementsandhowtheymayimproveglucosecontrolsincethediscovery

ofinsulin.Alargefocusofthisresearchhasbeenontheinorganicdietaryminerals,principally

MagnesiumandZinc.

Magnesium,amacromineral,isneededinrelativelylargequantitiesinthebody.Magnesiumis

knowntobeacofactorandprecursortomorethan300enzymes.Meaningthatmagnesiumishighly

involvedinmanybiochemicalpathwaysthroughoutthebody,includingbloodglucosecontrol,

specificallyinglycolysis.4Mg2+isknowntoregulatethefunctionsofhexokinaseand

phosphofructokinase,twoofthemostimportantenzymesinglycolysis.4Itisbelievedthatproper

magnesiumintakecanassistinbloodglucosecontrolbyregulatingglycolysis,allowinginsulintobetter

carryoutitsfunction.

Zinc,atracemineral,isthoughttohavearoleinbloodglucosecontrol.1ResearchintoZinc’s

effectswascarriedoutpost2005,andameta-analysisof25studieswassubmittedtotheJournalof

DiabetologyandMetabolicSyndromein2012.5Themeta-analysispooleddatafromall25studiesand

foundsignificantreductioninfastingbloodglucoselevels,HemoglobinA1clevels,andLowDensity

Lipoproteinlevels,demonstratingthatzincdoeshasabeneficialeffectinpatientswithdiabetes,and

thatpatientswithdiabetesdidtendtohavelowerplasmazinclevelsthanhealthypatients.5One

explanationforZinc’seffectonbloodsugarisitsroleinthetransformationofproinsulin,theprecursor

forinsulin,toinsulin.Inthismechanism,zincionscombinewithproinsulintoformazinccontaining

hexamer,whichisreadilyconvertedtoaninsulinhexamer,whichcanthenbereadilyconvertedinto

standardinsulin.3ThisisdemonstratedinNPHandregularexogenousinsulins,whichareknownto

containzincions.3Itisthoughtthatproperzincintakecanincreasetheeffectivenessofinsulinby

assistinginthenormalactionpathwayofinsulin.

Overthecourseofthefollowingexperimentalprocess,thefeasibilityoftheadditionofdietary

zincandmagnesiumintofoodproductswhichmaybeeasilyincorporatedintothedietwillbetested.To

assessthisfeasibility,magnesiumandzincwillbeaddedtoapplesauce,tobeevaluatedforalterationsin

color,flavor,andoverallflavor.

OBJECTIVE

Thepurposeofthisexperimentistoassessthechangesinflavor,color,andviscosityimposed

onsplendasweetenedapplesaucebytheadditionofzincandmagnesium.Usingacontrolsampleof

plainsplendasweetenedapplesauce,zincsupplementedapplesauce,magnesiumsupplementedapple

sauceandapplesaucesupplementedwithbothzincandmagnesium,onesensorypanel,andtwo

objectivetestswillbeconducted.Theexactcolorvaluesofeachsamplewillbedeterminedusinga

standardcolorimeter,whileviscosityofeachsamplewillbedeterminedusingastandardBrookfield

viscometer.Todeterminethevariabilityinflavoramongthecontrolandvariations,a5-pointscalewill

beprovidedtoasensorypanel.Thepanelwillevaluateeachsampleforflavoronthisscale,with1being

thebestflavorand5beingtheworstflavor.

MATERIALSANDMETHODS

Toconductthisexperiment,andevaluatetheeffectofMagnesiumandZinconapplesauce,four

differentvariationswerecreated.Thiswasaccomplishedbyfirstmakingastandardapplesaucerecipe

using10Macintoshrecipe,2/3cupofsplenda,and5cupsofwater.Thestandardrecipewascreatedby

firstpeelingandcuttingtheapplesintosmallchunks.Thechunkswerethenwashedandplacedinatall

cookingpotwith5cupsofwater.Thewaterandappleswereleftontheoventopovermedium-high

heatuntiltheapplehadcookeddown.Oncethechunkedapplehadcookeddownintoapplesauce,the

splendawasaddedandstirredin.Thisstandardrecipewasthendividedintofourseparatecontainers.

Withinthefirstcontainer,thecontrolsamplewasplaced.Inthesecondcontainer,26mgofcrushed

purezincsupplementswereaddedtothestandardrecipe.Inthethirdcontainer,64mgofcrushedpure

magnesiumsupplementswereaddedtothestandardrecipe.Inthefinalcontainer,26mgofcrushed

purezincsupplementsand64mgofcrushedpuremagnesiumsupplementswereaddedtothestandard

recipe.Theamountofsupplementaddedwaskeptsomewhatlowinordertopreventacuteover

consumptionofthemineralsintestsubjectsduringtasting.

Thismethodologywasconductedonthreeseparateexperimentationdays.Oneachday,each

variationwasprovidedtothe16participantsforaffectivetesting.Eachparticipantwasaskedtoratethe

tasteofeachvariationonaLikertscalerangingfrom1-5,with1havingthebestflavor,and5havingthe

worstflavor.Theneachvariationwassubjectedtocolorimetrytestingandviscositytesting.The

colorimetrytestwasconductedusingastandardcolorimeter,withl,a-andb+valuesbeingrecorded.

TheviscositytestwasconductedusingastandardBrookfieldviscometer,usinga#1spindleandaspeed

of10.Eachcolorimetryandviscositytestwasconductedthreetimesoneachexperimentationday.

RESULTS

Table1

AverageAffectiveresultsforApplesauceVariations

ExperimentationDay

Experiment

ControlZinc

Supplement MagnesiumSupplementZn+Mg

Supplement1 1.2 2.5 3.7 3.92 1.3 2.9 2.8 4.63 1.4 2.1 3.8 4.0Note:Withintable1,theaveragesofeachofthreetrialsfortheaffectivetestforeachvariationis

provided.Thisdatawasattainedbysimpletastetastingconductedby16individualsusingaLikertstyle

scale.Thescaleusedincludedvaluesrangingfrom1-5,with1beingthebesttasting,and5beingthe

worsttasting.

Table2

AverageColorimetryofApplesauceVariations

Type Trial Lvalue a-Value b+valueControl 1 61.0 1.1 2.0

2 60.9 1.2 2.0 3 60.9 1.3 2.2

ZincSupplement 1 61.9 3.2 3.5

2 61.9 3.2 3.6 3 62.0 3.2 3.6

MagnesiumSupplement 1 62.6 0.2 7.5

2 62.8 0.2 7.5 3 62.8 0.2 7.6

Zn+MgSupplement 1 57.1 5.0 0.5

2 57.2 4.9 0.5 3 57.2 5.0 0.6Note:Withintable2,theaveragesofeachofthreetrialsfortheobjectivecolorimetrytestforeach

variationisprovided.Thisdatawasattainedbyusingastandardcolorimetertoattainl,a-,andb+

values.

Table3

AverageViscosityofApplesauceVariations

Sample Trial DialReading Viscosity(mPa*s)Control 1 12.8 128.3

2 12.7 126.7 3 12.9 129.0

ZincSupplement 1 14.5 145.3

2 14.5 145.0 3 14.6 145.7

MagnesiumSupplement 1 13.2 131.7

2 13.2 132.0 3 13.2 132.0

Zn+MgSupplement 1 15.1 150.7

2 15.1 151.0 3 14.9 149.0Note:Withintable3,theaveragesofeachofthreetrialsfortheobjectiveviscositytestforeachvariation

isprovided.ThisdatawasattainedbyusingastandardBrookfieldViscometertoattainthedialreading.

Thespindleusedwasthe#1spindle,ataspeedof10.Usingthesevalues,thefactorwasfoundtobe10.

Theviscositywascalculatedbymultiplyingthedialreadingbythefactor.

DISCUSSION

Uponanalyzingthedata,afewkeyconclusionscanbedrawn.Intable1,itcanbeseenthatthe

controlsampleofapplesaucewasindicatedtohavethebesttasteacrossallexperimentationdays.The

averagereportedflavoracrossallthreedaysforthecontrolsamplewas1.2,thehighestaverageamong

thesamples,whiletheZincandMagnesiumsample,onaverage,hadtheworstflavorwithanaverageof

4.2.Thezincandmagnesiumaffectiveaverageswerefoundtobe2.5and3.43respectivelyacrossthe

threeexperimentaldays.Itcanbeseenthatzincseemstohavelessofaneffectontheflavorofthe

applesauce,whilemagnesiumhadmoreofaneffectonflavor.Whenthetwocometogetherinthelast

variation,theflavorisperceivedasworsethantheadditionofeithersinglemineral.Itmaybepossible

tosupplementzincintoapplesauceproductswithminimaleffectontheperceptionofflavor,butmore

researchisneededtodeterminetheexactamountofzincneededtominimalizetheeffectonflavor.

Intable2,itisseenthatalthoughtheapplesaucevariationsweresimilarincolor,uponcloser

evaluation,thesamplesvariedacrossallrecordedvalues.Inthecaseofthelvalue(thelightness+or

darkness-ofthesample),wasthehighestinthemagnesiumcontainingsamples,andthelowestinthe

ZincandMagnesiumcontainingsample.Thisshowedthatthesamplewiththemostaddedsupplements

wasthedarkestsample.Thisshouldnotbesurprising,asthehighertheamountofsoluteaddedtoa

food,thedarkerthatfoodshouldbe.Inthecaseofthea-value(theredness+orgreenness-ofthe

samples),themagnesiumvaluewasfoundtohavethelowestvalue,whilethezincandmagnesium

samplewasfoundtohavethehighestvalue.Thiscouldbeseenevenwithoutcolorimetry.Thezincand

magnesiumsupplementedsamplewasvisiblygreenincolorwhentestingwasconducted.

Inthecaseoftheviscositytesting,itcanbeseenintable3thatwhiletheviscositiesaresimilar,

theydifferenoughtowarrantdiscussion.Thecontrolsamplewasfoundtobethemostviscosewithan

averageof128mPa*sacrossthethreeexperimentationdays,whilethezincandmagnesium

supplementedsamplewasfoundtobetheleastviscosewithanaverageof150.23mPa*s.Further,it

wasseenthatonaverage,themagnesiumsupplementedsamplewasmoreviscosethanthezinc

sample.Thiswasnotsurprising,asthecontrolsamplehasnoadditivethatcoulddecreasetheviscosity.

Themagnesiumsamplewasthesecondmostviscose,whichcanbeexplainedbymagnesium’slesser

molecularweightwhencomparedtozinc,yieldingahigherviscositythanthezincsupplemented

sample.

CONCLUSION

Inconclusion,ithasbeendemonstratedthattheflavor,color,andviscositywereindeed

effectedbytheadditionofzincandmagnesium.Despitethebenefitsoftheaddedzincandmagnesium

inthediet,itmaynotbelucrativetoaddthesemineralstocommonfoodproducts.Inthecaseof

applesauce,theadditionofthementionedmineralsgenerallymadetheproduct’sflavorworst.Thiswas

demonstratedbythecontrolgroupreceivingthebestflavorrating,withthesupplementedvariations

havingprogressivelyworseflavorrating.Itwasalsodemonstratedthetheadditionofthesupplements

drasticallychangedthecoloroftheproduct.Theadditionofsupplementsmadetheapplesaucedarker

andgreeneringeneral.Thisisnotthemostappealingappearanceandmayprovedifficulttomarketto

thosewithtypeonediabetes.Finally,itwasdemonstratedthattheadditionofthesemineralsmadethe

applesaucelessviscose.Itisnotclearifthiswouldaffectthemarketabilityoftheapplesauceassome

maypreferthickerapplesaucewhileothersmaypreferlessthickapplesauce.Inevaluatingtheflavor,

colorandviscosityinresponsetotheadditionofzincandmagnesium,itwasfoundthatitmaynotbe

feasibletoaddthesemineralstofoodproductstoassistintreatmentoftypeonediabetes,butmore

researchisneededtodetermineatwhatconcentrationtheseaddedmineralsbegintoeffectthe

characteristicsoftheproduct,andifthiseffectcanbeminimalizedandtheproductsputtomarket.

REFERENCES

1Chausmer,A.B.“Zinc,InsulinandDiabetes.”JournaloftheAmerican CollegeofNutrition17,no.2(April1998):109–15.

2deSena,KarineCavalcantiMauricio,RicardoFernandoArrais,Mariadas GraçasAlmeida,DinaMariadeAraújo,MirzaMedeirosdosSantos, VanessaTeixeiradeLima,andLuciadeFãtimaCamposPedrosa. “EffectsofZincSupplementationinPatientswithType1Diabetes.” BiologicalTraceElementResearch105,no.1–3(2005):1–9.

3Emdin,S.O.,G.G.Dodson,J.M.Cutfield,andS.M.Cutfield.“RoleofZincin InsulinBiosynthesis.SomePossibleZinc-InsulinInteractionsinthe PancreaticB-Cell.”Diabetologia19,no.3(September1980):174–82.4Garfinkel,L.,andD.Garfinkel.“MagnesiumRegulationoftheGlycolytic PathwayandtheEnzymesInvolved.”Magnesium4,no.2–3(1985):60– 72.

5Jayawardena,R.,P.Ranasinghe,P.Galappatthy,RldkMalkanthi,G.R. Constantine,andP.Katulanda.“EffectsofZincSupplementationonDiabetesMellitus:ASystematicReviewandMeta-Analysis.”Diabetology &MetabolicSyndrome4,no.1(April19,2012):13.Doi:10.1186/1758- 5996-4-13.

6Kelleher,ShannonL.,NicholasH.McCormick,VanessaVelasquez,and VeronicaLopez.“ZincinSpecializedSecretoryTissues:Rolesinthe Pancreas,Prostate,andMammaryGland.”AdvancesinNutrition:An InternationalReviewJournal2,no.2(March1,2011):101–11. Doi:10.3945/an.110.000232.7Lopez-Ridaura,Ruy,WalterC.Willett,EricB.Rimm,SiminLiu,MeirJ. Stampfer,JoAnnE.Manson,andFrankB.Hu.“MagnesiumIntakeand RiskofType2DiabetesinMenandWomen.”DiabetesCare27,no.1 (January1,2004):134–40.Doi:10.2337/diacare.27.1.134.

NUTR3000

Reviewofthephysiologicalandnutritiveimportanceofzinctranscribedpresentation.Slide1:ZincIntoday'spresentation,wewillbetakingabrieflookatZinc.Slide2:IntroductionAfterwatchingthispresentation,youwillgainadeeperunderstandingofthemicronutrientzinc,theimpactofzinconnormalphysiology,somegoodsourcesofZinc,recommendationsforZinc,andhowZincisabsorbedintothebody.ItshouldfirstbenotedthatZincisanessentialmicronutrient,meaningitmustbetakeninthroughnormaldietoradietarysupplement.Zincisahighlyinvolvedmicronutrient,playingapartincatalyticactivityinenzymes,immunefunction,normalproteinsynthesis,woundhealing,DNAsynthesis,andcelldivision.Zincalsoplaysanimportantsupportroleinnormalgrowthanddevelopmentduringpregnancy,childhood,adolescence.Zincisalsorequiredforpropersenseoftasteandsmell.Itisalsoworthnotingthatthebodydoesnothavespecializedzincstorage,therefore,zincintakemustremainconsistentthroughoutthelifespan.Slide3:GoodSourcesofZincThemainsourcesofzincincluderedmeatsandpoultryaswellasshellfishandfortifiedproducts.Zincisalsoabsorbedbetterwithanimalproteininthediet.Zincisalsocommonlysupplemented.Commonzinccontainingsupplementsincludezincgluconate,sulfateandacetate.Someotherlesstypicalsourcesincludehomeopathicmedicationsforcoldtreatmentandsomedentureadhesivecreams.Slide4:RecommendationsAspertheDRIssetbytheFoodandNutritionBoard,thecurrentRDAsforzincarelistedhere.ItshouldbenotedthattheRDAformalesinthe14-19-year-oldagerange,ishigherthaninfemalesinthesameagerange.Thisisduetozinc'skeyroleinsexualmaturationinmales.Slide5:Digestion&AbsorptionBeforezinccanbeabsorbeditmustfirstbehydrolyzedfromaminoacidsandnucleicacids.Theexactprocessisnotyetknownhowever;itisbelievedthattheacidicpHofthestomachandupperduodenumallowszinctoseparatefromfoodwiththehelpofproteasesandnucleases.Zincabsorptionthentakes

placeinthesmallintestineintheduodenumandupperjejunum.Mostoftheabsorptionofzincisaccomplishedthroughcarrier-mediatedtransport.ZIP4isthemostcommontransporterused.Itcarrieszincintothecytosolofenterocytes.Zinccanalsoenterenterocytesbydiffusionacrosstheirtightjunctions.ThismayoccurwhentherearenotenoughZIP4carriers.Tobetransported,Zincisboundtobloodproteins,likealbumin,thentakentotheliver.TheliverthanreleasesZincintocirculation.Incirculation,zincmaybeboundtoalbuminbutmayalsobindtootherproteinsfortransport.Thereisnospecificstoragesiteforzinchoweverzinccanberecycledwhenintakeislow.NormallyzincisexcretedmostlythroughtheGItract,butsomelossalsooccursthroughthekidneys,andthroughtheskin.Slide6:FactorsinfluencingZincAbsorptionSomewherebetween10-80%ofzincintakeisabsorbedduetodifferentfactorsthatcanincreaseordecreasetheabsorption.Typically,ligandsincreasetheabsorptionbecausezinccanbindtosulfurandnitrogeninthem.Ligandsmayalsoservearoleinhelpingzinctoremainsoluble.Forreasonsunknown,pancreaticsecretionsalsoappeartoincreasetheabsorptionofzinc.Anacidicenvironmentisalsokeythereforeanythingthatreducestheacidityoftheintestinaltractmayinhibitzincabsorption.Thiscanincludebothoverthecountermedications,likeantacidsandcertainprescriptionmedicationsthatwewilltalkaboutinanupcomingslide.Foodsmayalsodecreaseabsorptionofzincwhenzincbindswithphyticacid,oxalicacid,polyphenols,copper,ironorcalciuminthem.Ontheotherhand,iftheenvironmentistooacidicthatcanalsodecreasetheabsorption.Slide7:NutrientInteractionsAnumberofothermineralscanalsointeractwithZinc.Largeamountsofcopper,iron,andcalciumalldecreasezinc'savailability.Highintakeofzincitselfcandecreasetheamountofzincthatisabsorbed.Zinccanalsoinfluencevitamins.ItincreasestheabsorptionoffolateanditisessentialtothefunctioningofvitaminA.Slide8:HistoryofZincDeficiencyZincdeficiencywasfirstdiscoveredinthemiddleeastinchildrenandadolescentswhowereundersizedandunderdevelopedrelativetotheirage.Itwasattributedtothetypicaldietoftheregionwhichwashighinphyticacidfromlegumesandwholegrainsbutlowinanimalproteinslikepoultryandmeat.Thehighfiberandphytateswouldbindthezincallowinglesstobeabsorbed.Laterageneticdisorder,acrodermatitisenteropathica,waslinkedtozincdeficiency.Thisleadtomoreresearchandunderstandingofzinc.Slide9:SymptomsofZincExcess&DeficiencyTodaymoreisknownaboutzinc,however,researchhasbeenlimitedthusfarbyalackofspecificbiomarkersthatindicatezincstatus.Also,themethodsinwhichsomestudieshavemeasuredzincarerelativetopopulationsandnottransferabletoindividuals.Theimagetotherighthighlightssomecommonsymptomsofexcessanddeficiency.Inaddition,aULissetat40mgperdaysincetoxicitycanoccuratdosesgreaterthan50mgperday.Toxicityislesslikelytobestrictlyfromfoods.Itismorelikelywithsupplementationeitherdirectsupplementsoraspartofanoverthecounterproduct,likecoughdrops.Slide10:DeficiencyZincdeficiencyoccursacrossaspectrumwithmarginaldeficiencybeingmorecommonthanseveredeficiency.Itisawidespreadproblemwithover2billionpeoplehavingsomelevelofdeficiency.Mostatriskarechildrenindevelopingworlds.Thiscanleadtoimpairedphysicalorneurological

development.Inadequatezinclevelscontributetochildhoodmortalitybydecreasingthefunctioningoftheimmunesystemleavingindividualssusceptibletoinfections.Insomeinstances,individualsmayalsohavevisualdefectsespeciallyinnightvisionduetoinsufficientvitaminA.Zincisacomponentofretinolbindingproteins;theproteinisnecessarytotransportvitaminAintheblood.Incasesofseveredeficiencyoutcomesaremoresevereasyoucanseewhencomparingthelistontherighttothelistontheleft.Slide11:MapAsyoucanseefromthemapZincdeficiencyexistsinmuchoftheworld.Slide12:AtriskIndividualsforZincDeficiencyThelistofpeoplewhomaybeatriskforsomelevelofzincdeficiencyisquitelong.Pleasetakeamomenttoreviewthelist.Slide13:PregnancyZinchasproventobeaveryimportantmicronutrientduringpregnancy.TheRDAforzincforpregnantwomenis11mg/dayforadultsand12mg/dayforteenagers.Studiesshowthat82%ofpregnantwomenworldwidehaveinsufficientzincintake,however,deficienciesforpregnantwomenintheU.S.arerare.Someconsequencesofzincdeficiencyduringpregnancyincludelowbirthweight,prematuredelivery,laboranddeliverycomplicationsorcongenitalanomalies(birthdefects).Somereviewsofzincsupplementationtrialshavefoundthatzincsupplementationduringpregnancywereassociatedwitha14%reductioninprematuredeliveries.Thiseffectwasmainlyseeninthelow-incomewomen.Otherstudieshaveshownthatalthoughzincdeficiencycanhavedevastatingeffects,theeffectsofsupplementationonpregnancyoutcomeshavelimitedbenefits.Thiswasmoreinhealthyaverageadults.Becauseofthis,itishypothesizedthatzinchomeostaticadjustmentsduringpregnancyimproveutilizationtoprovidetheincreasedzincneeds,lesseningsomeimmediatedetrimentaleffects.Slide14:LactationTheRDAforzincduringlactationrisesslightlyto12mg/dayinadultsand13mg/dayinteenagers.Zincconcentrationsinbreastmilkslowlydeclineduringthefirst6months.Itstartsoutwith2-3mg/dayinmilkduringthefirstmonth.Thisamountdeclinesto1mg/dayby3monthsandcontinuestodeclinetoabout0.5mg/dayaround6months.Thehighneedsforzincduringearlylactationaremetbyusingmaternalzincpools.30%ofthebody’stotalzincisstoredinbonetissue.Becauseofthehighneedsforzincduringthefirst6monthsofexclusivebreastfeeding,about4-6%ofmaternalbonemassislostduringthistime.Manywomenhavereportedthatmaternalzincsupplementshavebenefits.Oneexampleofthisisthattheyslowtherateofdeclineinmilkconcentrationsduringlactationwhichcanbeaproblemforsomebreastfeedingmothers.Otherreportsshowarelationshipbetweenzincsupplementationandbreastfeedingretentionrates.Slide15:InfancyInfants’ages0-6monthshaveanadequateintakerecommendationof2mg/dayandinfantsages7-12anAIof3mg/day.Zincdeficiencyininfantscancauseproblemsthatwillaffecttherestoftheirlives.Deficiencyininfancyandchildhoodisassociatedwithreducedimmunocompetenceandincreasedinfectiousdiseasemorbidity.Zincsupplementationininfantsisassociatedwithasignificantlylowermortalityrate.Thisissignificantbecausecalcium,phosphorus,folateandironsupplementswerenotassociatedwithmortalityreduction.Zincsupplementsinsmallforgestationalageinfantscanresultinsubstantialreductionininfectiousdiseasemorbidity.Slide16:Children

Zincisanimportantmineralforgrowthanddevelopment,andisespeciallyimportantforyounggrowingchildren.ThecurrentRDAvalueforchildrenages4-8is5mg/dayandforchildrenages9-13is8mg/day.Ifchildrenarenotconsumingadequatesourcesofironintheirdietorexperiencingsymptomsofdeficiency,supplementationmayberequired.Slide17:GrowthandSexualDevelopment

Zincisakeymineralforsexualgrowthanddevelopment.Azincdeficiencycanresultindwarfismandhypogonadism,butwithpropersupplementationgrowthanddevelopmentwillimprove.

AresearcherstudyinginIranwaspresentedwitha21-year-oldman"wholookedlikea10-year-oldboy",hesaid.Hereferredtohisgenitaliaas"infantile",thepatientexperiencedgrowthretardationandtesticularatrophyamongstothersymptoms.Uponexamination,theresearcherconcludedaZincdeficiencywasresponsiblefortheproblems.

Dataconcludedzincsupplementationiscapableofa12.7–15.2cmgrowthin1yearandthegenitaliacanbecomenormalagainwithin3–6months.

In1972,astudywascarriedoutinvolving15menand2women,ages19-20,allconsideredmalnourished.Onegroupreceivedawell-balanceddietwithaplacebocapsule,thesecondgroupreceivedawell-balanceddietwithacapsulecontaining27mgZinc,andthethirdgroupreceivedthewell-balanceddietwithnosupplementation.Resultsreported"Thezinc-supplementedgroupgainedconsiderablyinheightandshowedevidenceofearlyonsetofsexualfunctionasdefinedbynocturnalemissioninmalesandmenarcheinfemalescomparedwiththosereceivingonlyawell-balanceddiet".

Slide18:Diabetes

Zincisthoughttoplayakeyroleinthesynthesisofinsulin.Asearlyasthe1980’sresearchersobservedaninteractionbetweenZincionsandproinsulin,theprecursormoleculeofinsulin.Researchersbelievedthatproinsulinformedazinccontaininghexamer,whichisreadilyconvertedintoaninsulinhexamer,whichcanthenbeconvertedintoinsulin.

Infact,oldertypesofinsulinlikeNPHandRegularcontainzincionsinsolution.Whenlookingatindividualswithbothtypesofdiabetes,researchersobservedsomekey

differencesfromhealthyindividuals.Individualswithtypeonewerefoundtobezincdeficientinalmostallcases.Thosewithtypetwowerefoundtohavedecreasedzincbloodserumlevelsandhyperzincuria,orhighlevelsofzincintheurine.Otherresearcherscontinuedthisresearchandfoundthatinindividualswithhigherserumzinccontent,theriskofdevelopingtypetwodiabeteswasdrasticallylower.Slide19:ImmunologyZinchasmanydifferentroleswithintheimmunesystem.Itinfluencesthegrowthanddevelopmentofthehumanbody,andalsoplaysabigroleinfightingagainstinfection.Withoutzincinthesystem,ourbodieswouldbepredisposedtoinfectionandnotbeabletobuildupanimmunityagainstpathogens.Withzincinthesystemthough,ourliversareabletoreacttosuchimmuneresponsesfasterandcanexcretethenecessaryhormones.Slide20:Immunology

Zinchasfourdifferentrelationshipswithintheimmunesystem.Thedietaryrelationshipisthemostimportantbecausewithoutit,theotherthreerelationshipswouldnotbeabletocontinue.Zincneedstobetakeninandabsorbeddailyintocirculationsothatitcanbeavailablefornotonlytheimmunesystembutforalltheorgansinourbody.

OnceZincistakenin,itcaninfluencehoworgansfunctionandaffecttheimmunesystembybeingacofactortoover300differentkindsofenzymes.Zinc'sroleasacofactorismostlyastructuralrolewithsomeformsofenzymaticactivity.

Thedirectrelationshipofzincontheimmunesystemisthatitisinvolvedintheproductionandfunctionofwhitebloodcells,orleucocytes.Oncethesecellsarematured,theyareabletofightinfectioninallpartsofthebodybywayofcirculation.

Zincalsohasaminorroleininfluencingimmunostimulantswhichleadtomonokineandlymphokinesecretion,aswellaslymphocyteproliferation.Thesesecretionsactasmacrophagesthatareabletometabolizeendotoxinsinthebody.Slide21:Immunology

Aspreviouslystated,theroleofzincintheimmunesystemislargelyaffectedbyhowmuchistakeninandultimatelyavailableforuse.Whenthereisapathogenandtheimmunesystemistryingtofightitoff,Zinc’sroleistorecruitneutrophilstothesiteasanimmuneresponse.WhenZinclevelsarehigh,theNaturalKillercellthatisresponsibleforthephagocytosisofneutrophilsisinhibited,leadingtorapidhealing.Ontheotherhand,whenzinclevelsarelow,theNaturalKillercellisnotstoppedandthereforephagocytizestheneutrophilsandmacrophagesthatareresponsibleforhealingwhichmakesrecoverytimelonger.Slide22:Neurological

Ithasbeenuniversallyacceptedinthemedicalcommunitythatzincmetalions(Zn2+)areessentialtoproperfunctionofthebrain.Zincdysregulationhasbeenlinkedtoalarge(andgrowing)listofneurologicaldiseases,notably,Alzheimer’s,Parkinson’sSchizophrenia,Pick’s,etc.

OurunderstandingofthefulleffectofZinconproperneurologicalfunctionisstillinitsinfancy,however,zinchasbeenimplicatedinimproperDNA,RNAandproteinsynthesisduringbraindevelopmentininfants.Duetothis,ithasbeenhypothesizedthatzincdeficiencythroughoutthelifespanmayattributetothedevelopmentoftheneurologicaldiseasesmentionedabove.ItshouldbenotedthatzincsupplementationhasbeenusedtotreatWilson’sdisease,achrodermatitisenteropathica,andsometypesofschizophreniawithgreatsuccess.

FoodSystemsNUTR4100AssessmentofFoodAccessibilityinTypeIdiabeticchildreninSouthEasternOhioTitleand/orBriefDescriptionoftheLeadOrganization

AreviewoftheaccesstonutritioneducationservicesbychildrenwithTypeIDiabetesinAthensCounty.StatementoftheNutritionalProblem

Forthisassessment,theresearcherswillreviewtherateoffoodinsecurityandaccesstonutritioneducationdeficitsinchildrenage6to16livingwithTypeIDiabetes.DefinitionoftheCommunity

Forthepurposesofthisassessment,wewillbetargetingchildrenage6to16livingwithtypeonediabeteswithinAthensCounty,Ohio.PurposeoftheAssessment

Theoverallpurposeofthisassessment,istoidentifythelevelofaccesstonutritioneducationandhealthfulfoodsbyourtargetpopulation.Thisassessmentalsoaimstoexploretheunderlyingcausesofthepotentiallackofnutritioneducationandhealthfulfoodswithinourtargetpopulation.

TargetPopulation

Thetargetpopulationforthisassessmentincludesallthosebetweentheagesof6to16livingwithtypeonediabetes,withlimitedaccesstonutritioneducationandcare,whomaybestrugglingtomanagetheirconditionwithoutthesenutritionbasedservices.GoalsandObjectivesoftheNeedsAssessment

● Goal1:Toprovidemoreavailabilityandaccesstoquality,nutritionalcare.○ Objective1:EducateparentsonwhatTypeIDiabetesisandtheimportanceof

managingTypeIDiabetesintheirchildren.○ Objective2:EducateparentsonhowtogroceryshopandcookfortheirTypeIDiabetic

child.● Goal2:ToendfoodinsecurityintheAthensCounty.

○ Objective1:Educateparentsandfamiliesontransportationoptions.○ Objective2:Educateparentsonfoodsourcelocations

Ouroverallgoalsofourneedsassessmentaretoprovidemoreavailabilityandaccesstoquality,

nutritionalcareandtoendfoodinsecurityintheAthensCounty.Duetolimitedaccesstohealthcare,manychildrenwithType1Diabetesarenotreceivingtheeducationtheyneedinregardstooptimizingtheiroverallhealth.Qualitydiabetesmanagementiscrucialtopreventchronicdiseasesinthefuture.Foodinsecurityisanotherissue,whichiswhywewanttoprovidewaystoaccessaffordable,healthyfoodmoreeasily.

Tomeetourgoals,wecameupwithaplanofaction.Wewilldesigneducationalhandoutswhichsummarizewhatdiabetesisandwhydiabetesmanagementissoimportant.Thehandoutswillalsoincludecomponentstoahealthydiet.Alistofresourcestofoodwillalsobelistedonthehandouts,consideringalargeamountoffamiliesinthecommunityarefoodinsecure.ThesehandoutswillbepassedouttobothhealthcarefacilitiesandschoolsacrosstheAthensCounty.

Tomakesuretheeducationisprovidedtoourpopulationinneed,wewillbehandingoutthehandoutstoallthefacultystaffintheschools.ThiswillensureeverysinglediabeticchildintheAthensCommunityreceivesthegeneralinformationtheyneed.Wewillalsomakesurealldoctorsandendocrinologistspassoutthehandoutstotheirtype1diabeticpatients.Anothergoaltoourplanofactionistohaveanutritionistcomeintoalltheschoolstotalkaboutwhyahealthydietissoimportantforoverallhealth.Notonlywillthisbenefitourtargetedpopulation,butitwillalsobenefitallchildrenintheAthensCommunity.Ourlastgoalforourplanofactionistomailoutoremailoutaninvitationtoalltheparentswithchildrenwithtype1diabetes,invitingthemtoattendaparent/childCHIPbasedprogram.Itwillincludedoctors,RD’s,teachers,parents,andstudents.Thisprogramwillalsoincludegrocerystoretours,cookingdemos,anddiabeteseducationworkshops.

Toensurethatouractionplanisimprovingourtargetpopulation’soverallhealth,wewillmonitorandevaluatecertainaspects.Wewillfirstseeifthereisanoverallimprovementinthechildren’sbiochemicalvalues,suchasbloodglucoseandHbA1C.Wewillalsorecordwhatchildrenare

eatingatlunch,inhopesthatoverallfruit,vegetable,wholegrainandmilkconsumptionincreaseandlesssugaryandprocessedfoodarebeingconsumed.Wewillalsorecordhowmanyparents/childrenattendtheCHIPprogramevents.

DataCollectedBackgroundConditions

InAthensCounty-Ohio,only16.1%ofresidentsundertheageof65arereportedtohavehealth

insurancecoverageperthe2010-2014UnitedStatesCensusBureau.3Frompreviousresearchithasbeenfoundthatduetothelackoflackofnutritioncarecoverage,nearly45,000annualdeathsareassociatedwiththislackofhealthinsurance.Fromthisstudy,ithasbeenfoundthatthosewhodonothavehealthinsurancehaveahigherriskofdeathevenafterthesocioeconomic,healthbehaviorsandbaselinehealthperanewstudypublishedonlinetodaybytheAmericanJournalofPublicHealth.45,000annualdeathsareabouttwoandahalftimeshigherthananestimatefromtheInstituteofMedicine(IOM)in2002.4Inconclusion,therateofdeathincreasesinthosewhodidnothavehealthinsurancecoverage.CommunityCharacteristics

InAppalachia,itisestimatedthat48.8%ofhouseholdsaresaidtobefoodinsecureperdata

collectedin2004.6Comparatively,thenationalrateoffoodinsecurityisestimatedat14%ofhouseholds.Whenahouseholdissaidtobefoodinsecurethereisalackoftransportation,healthyfoodisnotavailableatalltimes,andthehealthyandbasicfoodsarehighlypriced.

Appalachianculturemaybeacontributortowhyitishardtomaintainahealthydiet,makingitharderforindividualswithdiabetestomanagetheirglucoselevels.MostAppalachianstaplefoodsarefriedfoodshighinfat.Somecommondishesincludechickenanddumplings,cornbread,greenbeans,biscuitsandgravy,andfriedapplepies/desserts.Also,theAppalachiancommunityhasstruggledwithfoodinsecurityovertheyears.Grocerystoresandfarmer’smarketshavebeendecreasing,makingitharderforfamiliestoaccessfreshandlocalfoods.Fastfoodcompanieshavealsoincreasedinavailability.TheseeatinghabitsintheAppalachianculturemaycontributetowhyobesityratesaresohigh,andwhyitmakesdiabetesmanagementachallenge.EnvironmentalCharacteristics

InAthensCounty-Ohio,thereare36physicians’officesthatthecommunitymembercangotoforhealthneeds.9ThefacilitieswherethereisnutritioncareinAthensCounty-Ohioare:WIC,O’blenessHospital(OhioHealth),TheDiabetesandEndocrineCareCenter(DECC)withinDiabetesInstitute(managedbyUniversityMedicalAssociates(UMA)inpartnershipwiththeHeritageCollegeofOsteopathicMedicine).8

AthensCountyhas49outof1,606householdswithoutvehiclesthataremorethanone-halfmilefromaSupermarketmeaningAthensCountydoesnothavearelativelyhighnumberofhouseholds(49of1,606totalhouseholds(3%))withoutvehiclesthataremorethan1/2milefromaSupermarket.11 AthensCountyhasapublictransitservicethatoffersfivedailyroutes.Thepublictransportationsystemislimited,butithasseengrowthinrecentyears.ThemostsignificantpartofthesystemistheAthenscitybusservice.ThebusestravelallaroundthecityandouttothevillageofThePlainswhichisapartofAthensCounty.Currently,thebusesdonottravelanywhereelseinthecounty.Thebussystem

providesavaluableservicetopeoplelivinginsideAthensandThePlains.ThebussystemdoesnotofferanyserviceonSunday,though,andmainlyonlyoperatesbetween7a.m.and7p.m.duringtheweek,soitisnotavailableatalltimeswhenpeoplemayneedtransportationtotheSupermarkets.1Inaddition,manypeoplewithoutreliabletransportationoftheirowncannotaffordtoliveinAthensCountyandlivewherethepublictransitservicedoesnottravel.Thesepeopleneedsomesortofassistancetogettohealthcareappointments,work,jobinterviewsandtootherappointments. Alongwiththepublictransitservice,AthensCountydoeshavesometaxiservicesthatprovidetransportationinthecityandintheoutlyingareas,butthisserviceiscouldbetooexpensiveformanyresidentsbecauseoftheirlevelofincome.

Forseniorcitizensandlowincomearearesidents,orindividualswithdisabilities,HAPCAPstartedtheAthensonDemandTransitinNovember.2Thisserviceoperatesfrom8a.m.until9p.m.MondaysthroughSaturdaysandprovidestransportationtoandfrommedicalappointmentsandsocialservicesappointments.Asspaceisavailable,theprogramwillalsoofferridestoworksites,grocerystoresandotherlocations.Theprogramcurrentlyhastwominivans,whileadditionalminivanswillbeadded.Ifthisvaluableservicecanbeexpandedtoprovideadditionaltransportationoptions,itwillbeatremendousbenefittothecommunity.

HAPCAPalsooperatesaMobilityManagementProgramthathelpstocoordinatetransportationservicesallacrossthecounty.CoordinatorLantzReppworksinavarietyofwaystohelpAthensCountyresidentsaccessthedifferentprogramsavailablewhilehealsoexploresnewopportunitiestoimprovetransportationoptionsforallAthensCountyresidents.SocioeconomicCharacteristics

AthensCounty-Ohiohasahighlevelofpovertyandlowmedianhouseholdincomereportedbythe2010-2014UnitedStatesCensusBureau.Accordingtocensusdata,Athenscountyhasapovertyrateof29.9%.3Thislevelisnearlydoublethenationalrateof14.5%,andis13%higherthantheAppalachiarateof17%.3Alsoaccordingtocensusdata,themedianhouseholdincomeintheUnitedStatesis$53,657,whilethemedianinAthensCountyis$33,773.3

ThelevelofeducationthatparentsinAthensCounty-Ohioisreportedbythe2010-2014UnitedStatesCensusBureau.Accordingtothemostrecentcensusdata,88.0%ofresidents,ages25yearsorolder,inOhiohaveahighschoolgraduateorhigherwhile89.4%ofAthenscountyresidentshaveahighschoolgraduateorhigher.3Itisreportedthat25.6%ofresidents,ages25yearsoldorolder,inOhiowhile28.8%ofresidentsinAthensCountyhavebachelor’sdegreeorhigher.3TargetPopulationData

Approximately48.8%ofhouseholdsinAthensCountyarefoodinsecureaccordingtoUSCensus

data.3Itcanbeestimatedthatnearlyhalfofourtargetpopulationliveinfoodinsecurehouseholds.OnlythreelocationsinAthensCountyoffernutritioncounselinggearedtowardsourtargetpopulation.ThethreelocationsthatprovidethisserviceareO'blenessMemorialHospital,WIC,DiabetesEndocrineCenter.9ExecutiveSummary-1-2paragraphsonStep3(seeBlackboard) AthensCounty-OhioislocatedinruralAppalachia,consideredinpovertyduetolowincomelevelsandfoodinsecurewithOhioUniversitylocatedinthecenterofthecommunity.ThehealthstatusofAthensCountyis“uncontrolled”duetolackofnutritioneducation,lowlevelsofhealthinsurance,foodinsecurity,andhighpovertylevels.TherearemanyhealthproblemsinAthensCountywithlittleto

notransportationtoreceivehealthcareorgettonutritiousfood.ThecurrentresourcesavailabletoresidentsareDiabetesOutreachSupportandEducationforStudents(DOSES),DiabetesandEndocrineCenter,OhioUniversityDiabetesInstitute,AthensKidsClub,CollegeDiabetesNetworkandO’blenessHospital.Thehealthcareavailableforthetargetpopulationisindicativeoftheaccessofthelargercommunity,servicesandsupplementalcaremaynotbeavailableinthisarea.Thewidespreadlackofhealthinsurancedisallowsthecommunityfromaccessinthecarethattheyneed.Thehealthstatusrelatestoenvironmentalandsocialcharacteristicsbypopulationnothavingalargeamountofhealthcareprovided.ThereisahighlevelofpovertyandlowmedianhouseholdincomeinAthensCounty.

InAthensCounty,thehouseholdsaresaidtobefoodinsecurewhichmeansthereisalackoftransportation,healthyfoodisnotavailableatalltimes,andthehealthyandbasicfoodsarehighlypriced.Thereisalackoftransportationavailabletocommunitymemberstoreceivehealthcarefromthe36physicianofficesandthethreelocationsthatprovidenutritioneducation.WhiletheeducationlevelofadultsishighinAthensCountycomparedtoratesinOhio.Finally,thepovertylevelinAthensCountyishighcomparedtonationalratesmeaningtheoverallstateofthetargetpopulationisaffectedbythislowlevelofincome.Feedback

Toensurethatourneedsassessmentisbeingputintoactionappropriately,wewouldwantto

advertiseourmissionandgoalstothetargetpopulationweareprovidingfor.Sinceourtargetpopulationisforchildrenfromages6-16withtype1diabetes,wewouldwanttoadvertisetothechildrenaswellastheparents.Therefore,wewouldhaveanarticleintheAthensNewspapertospreadtheawarenesstothegeneralpopulation,thatwayparentscanseetheavailablenutritionresourcesfortheirchildrenwithtype1diabetes.WewouldalsopassoutflyersindoctorofficesaswellasprovideflyersinalltheschoolsacrosstheAthensCounty.Childrencanthentakehometheflyerstotheirparents.Webelievetheawarenesswouldbeeffectivelyspreadthisway.References:1AthensPublicTransit."FullMapandSchedule."AthensPublicTransit.Web.27Apr.2016.2AthensCountyJobandFamilyServices."LackofTransportation."Athensoh.org.Web.27Apr.2016.3Census."PopulationEstimates,July1,2015,(V2015)."AthensCountyOhioQuickFactsfromtheUSCensusBureau.Web.27Apr.2016.4Cecere,David."NewStudyFinds45,000DeathsAnnuallyLinkedtoLackofHealthCoverage."HarvardGazette.Web.27Apr.2016.5DeWitt,David."StudyChroniclesTransportationChallengesforPoor."TheAthensNEWS.Web.27Apr.2016.6FeedingAmerica."FindYourLocalFoodBank."FeedingAmerica.Web.27Apr.2016.7Flasher,WanemaC."Ohioline."CulturalDiversity:EatinginAmerica-Appalachian.Web.27Apr.2016.8Mezitis,Nicholas."OhioUniversity."DiabetesandEndocrineCareCenter.Web.27Apr.2016.

9SimplyMap."OULibrariesEZProxy."OULibrariesEZProxy.Web.27Apr.2016.10Sohn,Mark."AppalachianFood."MountainPromise.Web.27Apr.2016.11USDA."USDAERS-GototheAtlas."USDAERS-GototheAtlas.Web.27Apr.2016.NUTR4100UNworldfoodprogramagencyreview

GeneralEducation

COMS1010InterpersonalawarenessanddevelopmentactivityAftercompletingChapter6,IfeelthatmyinterpersonalskillsneedthemostworkintheSelfDisclosurearea.Thebookdefinesitasthe“processofmakingintentionaldisclosuresaboutyourselfthatotherswouldbeunlikelytoknow”.Myproblemis,Inevergaugehowfastorhowslowtheprocessshouldbegoing,orifwhatI’mdisclosingcouldbeusedtohurtmeinthelongrun.Ithinkthisstemsfromamilitaryfamilythatvaluessecurity.Ineverliketoleakinformationaboutmyselfthatcouldbeusedbyothersagainstme,evenifitisasignificantother.I’vealwaysbeenafraidtoletslipthewronginformationonlytohaveitblowupinmyfacelater.Irealizethatself-disclosureisakeycomponentforanyrelationship,andIdoeventuallydisclosedelicateinformationaboutmyselfinarelationship,butbecauseI’msowithholdingofinformation,Ineverknowwhatinformationtogiveatwhatpoint.Whatseemssmalltosomeoneelsemightbetheworldtomeandwiththatinmind,it’sdifficultformetogiveouteventhesmallestdetails.Turningtothebookforassistance,I’vefoundthatoutofalltheskillbuildingtoolsthatitoffers,Ifind1.)Beingwillingtodiscloseand2).Graduallyincreasingdisclosureastherelationshipdevelopstobethemosthelpful.Togettothatpointofbeingwillingtodisclose,IbelievethatImustfindsomeonethatIsharealotofsimilaritieswithandhavebeenaroundforawhile.Arelationshipthatcatchesfireabittooquicklyisprobablynotidealforme,asIdon’tknowhowwellIcantrusttheotherperson.So,Ithinkmyfirststeptoimprovemyinterpersonalcommunicationistotrytoallowmyselftotrustpeople.FromthereIwillstartassmallascomfortablypossibleinmydisclosuresandtrytoexplaintotheotherpersonthatalthoughmydisclosuresmaybesmall,I’mtryingtotrustthepersonandletthemknowme,andthatittookagreatefforttodiscloseinformationtothem.FromthereIneedtocomfortablenavigatemywaytomoreintimateinformationuntilIcandisclosethingsthatImayhaveonlyevertoldthatperson.AfewothertipsfromthebookIfoundtobehelpfulincluderevealinginformationatthesamepaceandwiththesamedepthastheotherpersonandnotdisclosingnegativeinformationuntiltherelationshipiswellestablished.LikeIsaidabove,I’veneverbeengoodatjudgingwhatinformationIshoulddiscloseatwhatpointintherelationshipbeforethisclass.Ifyouare“pinging”offtheamountofinformationthattheotherpersongivesyou,itmightallowthebuildingoftrusttooccurquickerasyouhavecomparableinformationabouteachother,whichallowsforaspecialtypeofbondbetweenthepair.Thesecondtipmightseemobvious,butweallhavethosemomentswherewemightaccidentallysaysomethingwedidn’tmeantoandbestuckinthepit.Ithinkingeneralthough,it’sagoodtip;youdon’twanttomakeyourselflookbadwhileyouarestilltryingtobuildastrongrelationship.Waituntiltherelationshipiswellestablishedandwhatyouperceivedasnegativeinformationmightbesomethingthetwopeoplecanlookbackandlaughat.MathematicalReasoning

NutritionCareProcessNUTR3100ADIMENoteforHypertensivePatient

A

62-year-oldmale,hypertensive.Ht:5’9”,Wt:110kgBMI:32.5

Medications:CholestyramineMedicalHistory:Hypercholesterolemia,HypertrigylceridemiaLabValues:

Cholesterol:265mg/dLLDL:160mg/dLHDL:35mg/dLApoA:75mg/dL

ApoB:142mg/dL

Triglycerides:200mg/dLBloodPressure:160/100

EER:2626.9kcalEstimatedEnergyIntake:2390kcalBMI:32.5DietBehaviors:Patientdoesnotcook

often.Statesthathiex-wifedidmostofthecooking.Throughhiscareer,hebecameaccustomedto

greasyfastfoods,andhasnointerestinlearningtocook.Believescookingisn’tworthhistimeandalso

statesthathealthyfoodtastesbland.

D

Excessivefatintake(NI-5.5.2)relatedtoadietabnormallyhighfatdietasevidencebyHDL<45mg/dL,

LDL>130mg/dL,cholesterollevelsof265mg/dL,andtriglyceridelevelsof200mg/dL

Notreadyforlifestylechange(NB-1.3)relatedtounwillingnesstocookhealthyfoodinthehome,as

evidencedbypatientindicationofalackofinterestincookingasitisperceivedtobeawasteoftime.

I

Fatmodifieddiet(ND-1.2.5)usingaslowintroductiontotheMediterraneandiettolowerserumlipid

levels,increaseintakeofantioxidants,andpromoteoverallhealth.

OutcomeGoals:1.DecreaseSerumLDLandCholesterol2.IncreaseserumHDL3.Decreasefattyfood

intake4.Increaseintakeoffruits,vegetables,fish,andnuts

ActionGoals:Patientagreestocookinthehome.Patientagreestoshopforfatreducedfood.Patient

agreestomodifydiettoincludeelementsoftheMediterraneanlifestyle.

I(M/E)

Willfollow-upwithpatientinonemonthtoassesssuccessofattemptedchanges.Whennewserumlab

valuesbecomeavailable,clinicalwillusethesenewvaluestoassesssuccessofthissetofchangesand

reevaluateisnecessary.

4.Increaseintakeoffruits,vegetables,fish,andnuts

ActionGoals:Patientagreestocookinthehome.Patientagreestoshopforfatreducedfood.Patient

agreestomodifydiettoincludeelementsoftheMediterraneanlifestyle.

I(M/E)

Willfollow-upwithpatientinonemonthtoassesssuccessofattemptedchanges.Whennewserumlab

valuesbecomeavailable,clinicalwillusethesenewvaluestoassesssuccessofthissetofchangesand

reevaluateisnecessary.

NUTR4100NutritionCarePlanforB-LymphomaPatient

Heading

DDx:____pointsDx:____pointsDx:____points

A

(EachPES

statementis

worth4points)

UnsupportedBeliefsaboutnutritionrelatedsubjects(NB-1.2)relatedtodesireforacureforachronicdiseasethroughtheuseofalternativetherapyasevidencedbyreported“anti-cancer”faddiet,energyandproteinintakeimbalances,andintakeofalternativedietarysupplements.Malnutrition(NC-4.1)relatedtophysiologicalcausesincreasingnutrientneedsandnutritionrelatedknowledgedeficitasevidencedbydailyenergyintakeof<75%(1718kcal)estimatedenergyrequirement,dailyproteinintakeof<RDA(68.7g),andunintendedweightloss.

MasticatoryDifficulty(NC-1.2)relatedtoxerostomiaasevidencedbyoralmanifestationofcancerdiagnosis.

I(M/E)I:____pointsM/E:____points

PIntervention:6.5

pts

M/E;2.5pts)

1.)RecommendIncreasedEnergyDiet(ND-1.2.2.2)andTextureModified;EasytoChewDiet(ND-1.2.1.1)Recommend2000kcal/day,texturemodifieddiet,withfrequentfeedings,toensureahealthfuldiettoallowthepatienttosuccessfullyundergochemotherapytreatment.

2.)Achievepropernutrientintakethroughdietarymeans,whileeliminatingunnecessarysupplementswhenneeded.

3.)Outlineprioritymodificationsasrelatedtocancerdiagnosis.Specifically,propercaloric,protein,andcarbohydrateneeds.

4.)ProvideNutritioncounseling,focusingonself-managementandstressmanagement.

Outcomegoals:

IncreaseEnergyandProteinIntake.

Employeasytochewdiettoalleviatemasticatorydifficulty.

Actiongoals:Patientagreestodiscontinuecurrent“anticancerdiet”infavorofageneralhealthfuldiet.Patientagreestoadopt2000kcal/daydiet,incorporatingproperproteinintakeof~70g/day.Patientagreestokeepafoodloginordertoensuretheconditionsofahealthfuldietarebeingmet.Patientsfamilyagreestodiscontinueuseof“anticancerdiet”andundergofoodandnutrition-relatededucationtograsptheimportanceofahealthfuldietasitrelatestocancer.

Willfollowupwithpatientin3months,thenevery6monthsfollowingthefirstfollowuptoreviewpatientfoodlogtoassessadherencetonewdietplan.

Signature-1pt

WritingStyle

Overallimpressionofthenote.Writingstyle,neatness

NUTR4100NutritionCareplanforGIpatientfocusingonOstomyCare

Heading

A(3pts)

S

Patientstatesahistoryofhavinga“funny”stomach”(historyofasensitivestomach).Patientstatesthatshediscontinuedthemodifiedfiberdietaftershe“feltbetter”anddidn’tfeelitnecessarytocontinuethediet.Patientstatesthatshehasa“goodappetite”.Patientstatesthatherconditionhasgottenworseinthepastyear,especiallyinthespring.

O

AnthropometricsAge:53Height:5’4”Weight(6moprior):170lbsWeight(Admission):165lbsBMI(6moprior):29.27BMI(Admission):28.4IdealBodyWeight:120lbs%IdealBodyWeight:137%UsualBodyWeight:170lbs%UsualBodyWeight:97%TotalEnergyExpenditure:2077kcal/day

BiochemicalHgb:11g/dLHct:35%WBC:13*10^3

ClinicalSeverePaininlowerleftquadrantSevereConstipationanddiarrheaDiverticulitisintheSigmoidanddescendingcolonRectalBleeding

Diet/LifestylePatientisactive;ManagesFamilyFarmwithHusbandNormalDietuntildiverticulitisdiagnosisLowfiberdietprescribed;notfollowedtocompletionNutrientAnalysis(FromRecall):Kcal/day:1762.35kcalDailyGoal:1840kcal

Protein:103.54gCarbohydrates:76.54gFat:122gSodium:620.37mgPotassium:2403.6mgMagnesium:914mgVitaminC:87mgIron:17.5mgHistoryHypertension–Father’sSideCerebrovascularAccident–BrotherMultipleMyocardialInfarctions–FatherStroke–FatherIntestinalCancer–MotherAbdominalpaininlowerleftquadrantIncreasedFlatus

DDx:____pointsDx:____pointsDx:____points

A

(EachPES

statementis

worth4points)

FoodandNutrition-RelatedKnowledgeDeficit(NB-1.1)relatedtolackofpriornutritioneducationrelatingtocolostomybasednutritionasevidencedbychangeindiverticulitisdiagnosisandcolectomyrequiringtheuseofacolostomyLimitedAdherencetoNutrition-RelatedRecommendations(NB-1.6)relatedtofoodandnutrition-relatedknowledgedeficitconcerninghowtomakenutrition-relatedchangesasevidencedbyinconsistentcompliancewithnutritionplanrelatedtodiverticulitisdiagnosis.AlteredGastrointestinalFunction(NC-1.4)relatedtoalterationingastrointestinaltractstructureasevidencedbycolectomyprocedure.

NUTR4100NutritionCareplanforCysticFibrosisPatient

I(M/E)I:____pointsM/E:____points

PIntervention:6.5

pts

M/E;2.5pts)

NutritionEducation(E-1)relatedtorecommendedmodificationspertainingtoacolostomy,thepurposeoftherecommendedmodificationsastheyrelatetothecolostomyandoverallhealth.OutcomeGoals:ModifyDiettoensurehealthycolostomyPreventblockageofostomyActiveGoals:ClientagreestoattempttoincorporatehigherfiberfoodsintothedietClientagreestoincreasefluidintakeClientagreestoadheretoaregularmealscheduleClientagreestoavoidfooditemsthatmayresultinacloggedostomyClientagreestokeepalogofmonitoringandmanagementbehaviorsonadailybasisWillfollowupwithpatientafter1monthandthenevery3monthsafterwardstoassessadherencetointerventiongoalsbyevaluatingpatientself-adherencescores,theabilityofthepatienttorecallnutritiongoals,andalogofself-managementandself-monitoringdailyasagreedupon.

Signature-1pt

WritingStyle

Overallimpressionofthenote.Writingstyle,neatness

Heading

A(3pts)

S

Patientstatesthathehasbeenexperiencingfrequentcramping.Patientstatesthathehasbeenexperiencingfrequent,severediarrheawhileatschool.Patientstatesthatheexperiencesabnormallylargevolumeoffecalexertionwheneatingchipsandcheese.Patient’sparentsstatethattheyhavebeenrestrictingfatintactduetoabnormalfecalsmell,statingthatit“can’tbegoodforhim.”Patient’sparentsstate“atleasthe’sgettingenoughcalories”whendiscussingtheirlackofknowledgeonwhattypeofdiettheyshouldbefacilitating.

O

AnthropometricsAge:10y.o.Height:1.31mWeight(Admission):22.75kgBMI(Admission):13.2ApproximateIdealBodyWeight:31.75%IBW:71.65%TotalEnergyExpenditure:REE=(22.7*wt+495)=1011kcalTEE=REE*(AC+DC)=1920kcalDER=TEE*(0.93/CFA)=2100kcalTSF:4.5mmArmcircumference:16.70cm

BiochemicalHbA1C=7.1%

ClinicalManifestationofclubbingofthefingersandtoes.Patientappearspaleandextremelythin.

Diet/LifestylePatientisactive,contentandwellbehaved.Noaltereddietspecifiedasofyet.Dietplanisregularastoleratedbythepatient.Parentshavegoodhealthinsuranceandthemeanstoprovidefoodandadequatecare.NutrientAnalysis(FromRecall):Kcal/day:1153Protein:48gCarbohydrates:217gFat:103.77g(9%)

Sodium:2144mgPotassium:2274mgMagnesium:173mgVitaminC:108mgIron:9mgVitaminA:362ugRAEVitaminD:5ugVitaminE:1mgATVitaminK:49ugHistoryPatient’ssiblingpassedatayoungage;CFrelated

DDx:____pointsDx:____pointsDx:____points

A

(EachPES

statementis

worth4points)

InadequateFatIntake(NI-5.5.1)relatedtoalterationingastrointestinaltractfunctionasevidencedbyestimatedfatintakesbelowtherecommendedlevelandfatmalabsorptioncausedbycysticfibrosis.InadequateVitaminA,D,E,&Kintake(NI-5.9.1)relatedtophysiologicalcausesincreasingnutrientneedsrelatedtoimpairedfatutilizationduetocysticfibrosisasevidencedbyestimatedvitaminintakebelowtherecommendedlevel.ImpairedNutrientUtilization(NC-2.1)relatedtoimpairedexocrinefunctionofthepancreasasevidencedbycysticfibrosisdiagnosis.

I(M/E)I:____points

PInterven-tion:6.5

pts

M/E;

Increasedfatdiet(ND-1.2.5.1)tomeetphysiologicalneed,andtoaccountformalabsorptioncausedbycysticfibrosis.IncreasedVitaminA,D,E,&Kdiet(1.2.10)tomeetphysiologicalneed,andtoaccountformalabsorptionoffatascausedbycysticfibrosis.

NUTR4100NutritionCarePlanforImmunocompromisedPatient

M/E:____points

2.5pts) NutritionEducationpertainingtonutritionrelationshiptodisease(E-1.4)toensurethepatientandhisparentsareknowledgeableofdietaryneedsinrelationtohiscysticfibrosiscareandmanagement.OutcomeGoals:Modifydiettoensurerecommendedintakeoffatsandfatsolublevitamins.Preventmalnutritionandmanagemalabsorptionasitrelatestocysticfibrosis.Educateboththepatientandhisparenttothenutritiveneedsassociatedwithcysticfibrosistoensurequalityoflife.ActiveGoals:Clientagreestoattempttomodifythediettoincorporateahigherpercentageoffats.Client’sparentsagreetoattendtheNutritionEducationsessiontoensuretheirunderstandingthatahigherfatintakeisrequiredtomaintainthehealthoftheirson.Clientagreestoincorporatefoodsintothedietwhicharehigherinthefatsolublevitaminstoensurehealthyintake.Clientagreestokeepalogoffoodsbeingincorporatedintothediettomeettheincreasedfatandfatsolublevitaminneedstodemonstrateself-sustainabilityinmanagingthenewdiet.Willfollowupwiththepatientin1monthandthenevery3monthsafterwardstoassesscompliancewiththeinterventiongoalsbyevaluatingpatientself-adherencescores,parentadherencescores,andfoodlogreview.

Signature-1pt

WritingStyle

Overallimpressionofthenote.Writingstyle,neatness

Heading

D Dx: ____points Dx: ____points Dx: ____points

A

(Each PES

statement is

worth 4 points)

Inadequate energy intake (NI-1.2) related to decreased ability to consume sufficient energy as evidenced by patient statements regarding difficulty eating and soreness in the mouth and sustained weight loss since diagnosis. Masticatory Difficulty (NC-1.2) related to soft tissue disease as evidenced by patient statements on soreness of the mouth and HIV diagnosis. Unintended weight loss (NC-3.2) related to physiological causes increasing nutrient needs due to prolonged illness as evidenced by 82 %UBW, 96 %IBW, and weight gain recommendations by attending physician.

I (M/E) I: ____points M/E: ____points

P Interven-tion: 6.5 pts

M/E;

2.5 pts)

Nutrition education related to nutritional relationship to HIV using the cognitive-behavioral theory using social support to increase energy intake using a pureed texture diet. Outcome goals: Increase Energy Intake Decrease discomfort involved in eating Action Goals: Patient agrees to increase the number of calories eaten per day. Patient agrees to utilize a pureed diet to increase the volume of food eaten per day Patients partner agrees to support the patient in undertaking the pureed diet. Referral: Collaboration with attending physician to ensure overall health

NUTR4100CysticFibrosisandPancreaticFunctionEducationalHandOut

Signature- 1pt

Writing Style

Overall impression of the note. Writing style, neatness

ProfessionalDevelopmentProfessionalWritingLivingwithDiabetesinCollege:Charles

Foryoungadultslivingwithdiabetes,preparingforcollegecanbeadifficulttime.Managingdiabeteswhiletryingtomakesenseofanewworld,socialnetworkandexpectationscanbeespeciallychallenging.You’renotalone!Therearemanyresourcesinplacetohelpsupportthistransition.

ThefollowingarestoriessharedbyCollegeDiabetesNetwork(CDN)Students,involvedinCDN’sStudentAdvisoryCommittee(SAC),abouttheirexperiencesheadingofftocollege,andnavigatinglifeoncampus,withdiabetes.

TheCollegeDiabetesNetworkprovidesprogramsforyoungadultswithdiabetestohelpmaketheircollegeexperiencesaferandmoresuccessful.TheAmericanDiabetesAssociationisworkingwithCDNtohelpfurtherthisgoal.

NameandAge:Charles,21School:OhioUniversity,AthensCampus,Classof2017WhenIwasdiagnosedat14yearsold,myworldturnedupsidedown.Atthetime,IthoughtIwasgoingtoenlistintheMarineCorpsdirectlyoutofhighschool.Type1diabeteshadotherplansforme.AfterIhadacceptedIwouldbeattendingcollegeafterhighschool,IhadagoodideaofwhereIwantedtogo.OhioUniversitywasonlya20-minutecommutefromhome,hadtheonlyosteopathicmedicalschoolinthestate,anditevenhadaDiabetesInstitutewhereresearchscientists,clinicians,educatorsandstudentsmettoimprovethequalityoflifeforthoseaffectedbydiabetes.Itwastrulytheperfectschoolforme.Becausethecampuswassoperfectlysuitedtome,Ididn’tlooktoodeeplyintotheirmedicalaccommodationsorhealthservicesforstudents.Mydoctor’sofficeislessthanathree-minutedrivefromcampus,whichisahugeadvantage.EverythingIneededforcollege,forlifewithtype1ingeneral,wascloseathand.Thismademytransitionintocollegerelativelysimple—dareIsayeasy.Iknowothersaren’taslucky.ButtherealtransitionformewashowIinteractedwithmydiabetes.Type1canbestrainingonaperson,andsomemayevenfeelashamedbyit.ButpleasetrustmewhenIsaythattellingsomeoneaboutyourconditionisoneofthebestthingsyoucando.Thismaynotbetheeasiestthingforeveryonetodo.Talkingaboutitisareliefinitsownright.Onceyoucan“own”yourdiabetes,thenthereisnothingitcanthrowatyouthatyoucan’tovercome—butthatfirstrequiresyou

toembraceitandunderstandhowitcanaffectyourlife.Informthepeoplearoundyousotheycanhelpyouownit.Imakeeveryefforttocoexistwithmydiseaseratherthantofightit,andthatrequiresthepeopleclosesttometohaveadeepunderstandingofmydiabetesandwhattodointheeventofacrisis.Youneverhavetogoitalone!InmyhometownofGlouster,Iknowofthreeotherpeoplewithtype1diabetes.TwoofthemwenttothesamehighschoolasIdid.Youcouldsaythatoutsideofdiabetescamp,whichIattendedinthesummer,myinteractionswithotherpeoplewithtype1werenearlynon-existent.Thischangedinmysophomoreyearofcollege,whenmydoctorandsomeofthenutritionfacultyapproachedmeaboutstartingaclubforpeoplewithdiabetes.TheclubwouldgoontobecometheOhioUniversitychapteroftheCollegeDiabetesNetwork.Helpingtoco-foundthisgrouphashadaprofoundimpactonme.I’veconnectedwithleadersinthediabetessector,whichhasmademereevaluatehowIwanttocontinueintomycareer.Iwanttoworktowardbettertreatmentmethodsandtheever-elusivecure,butIalsowanttoworkoutsidethetraditionalrealmofmedicine.Iwanttosupportmypeerstofindthebestcourseoftreatmentratherthandictatingwhatthatmeans.Iwanttotreatthepeopleandnotjustthedisease.Iknowwhatit’sliketobeonthepatientsideofhealthcare;it’simportanttomakeitmorepersonal.EversincejoiningCDN,I’vebecomethe“diabetesguy”oncampus.Inhelpingtofoundourchapter,ImadecontactsinourDiabetesInstitute,ourmedicalschoolandourlocaldiabetesprograms.Iwasneverafraidoftalkingaboutmydiabetesbeforeenteringcollege,butinworkingwithCDNalongwithotherorganizations,Ibecameaself-proclaimedexpertintellingpeopleaboutit.Myfriendsandcoworkerscouldprobablytellyoumoreabouttype1diabetesthanyourtypicalperson,basedontheamountofinformationIpassontothem.Ifyou’reheadingofftocollegewithdiabetes,donotbeafraidtogetinvolved!Youneverknowwhois“touchedbydiabetes,”andyoumightbesurprisedbywhoisinterestedinworkingwithyouorevenjustsittingdownandhavingaconversationaboutdiabetes.Takeitfromsomeonewhowentitaloneallfouryearsofhighschool.Youcantackleyourdiabetesallbyyourself,itwillneverbeatyouunlessyouletit.Buthavingpeopleclosetoyouwhocanhelpyouwhenyouneedit—thatcanmakebeatingdiabetesalltheeasier.TheCollegeDiabetesNetwork(CDN)isa501c3non-profitorganization,whosemissionistousethepowerofpeers,accesstoresources,andgrassrootsleadershiptofillthegapsexperiencedbyyoungadultswithdiabetesandmaketheircollegeexperiencesaferandmoresuccessful.CDN’svisionistoempoweryoungadultswithdiabetestothriveinalltheirpersonal,healthcare,andscholasticendeavors.CDNhasover80campuseswith60+affiliatedchapters.Sign-upformoreinformationhere.DiabetesForecastmagazineandtheCollegeDiabetesNetworkrecentlypublisheda“ThriveGuideforYoungAdults”withtipsfordoingcollegewithdiabetes.Visitdiabetesforecast.organddiabetes.orgformoreinformation.

AADEClinicianCareguideforOmnipodIwasdiagnosedonMay8thof2008;atthetime,Iwas14yearsold.IstartedonNovologandLantusflexpensforthefirstsixmonths.IthentransitionedtotheOmnipodinNovemberof2009.IwasfortunateinthatIwasn’tevertreatedasachild.Itooktheinitiativeinmycare,beingolderformydiagnosisandbeingmoreabletotakecareofmyselfwithminimal(butnolessprecious!)helpfrommyparents.IhadanamazingDiabetologist.Hetreatedmenotasasickchild,butasaresponsibleadult,inchargeofmyowntreatment.Iwasnevertoldwhatmymethodofcarewouldbe.Hemaderecommendation,explainedtheprosandcons,andletmechoose,forthemostpart,whatwewoulddo.Youcouldalmostsaythatmytransitionfromchildcaretoadultcarehappenedatmytimeofdiagnosis.Thisiswhathasmademesosuccessfulinmyself-care.Idon’tresentmanagingmytypeonebecauseIalwayshadasay.Iwasalwaystheoneincontrolofmydisease,nottheotherwayaround.Iwouldsaythatishighlevelofautonomy,backedbyanexcellenthealthcareprovider,andamazingfamilysupportmadeitsothereweren’tany“roughspots”inmytreatmentfrommytimeofdiagnosisuntilnow.Lookingback,Iwouldn’thavechangedathing.Fromthis,Iwouldhopethatprovidersacknowledgeafewthings:First,diabetesisaself-caredisease.Mostofthecaredoesnotoccurinthepresencehealthcareprovider.Therefore,providersshouldgivetheirpatientsthereins.Iftheyarewellinformedoftheoptions,thebenefitsandthepotentialdownsides,theyshouldbetheonetomaketreatmentdecisions.Thisleadstohigherdiseaseefficacy,betterself-care,andahigherqualityoflife.Second,diabetes“child-care”shouldnotdiffertoogreatlyfromadultcare,butinsteadshouldbetreatedastypeonecare,ratherthangeneral“diabetes”care.Wecannothopeforthosewithtypeonetothrivewhenbeingtreatedasiftheyhavetypetwo,norviceversa.Thetwoaresimilar,butshouldnotbetreatedasthesame.Ultimately,theparentsandprovidershouldhaveagreaterinfluenceoncareforyoungerchildren,buttheymustbeallowedtolearnandgrow.2016CollegeDiabetesNetworkAHEADProposalAHEAD2016:ExcellenceandEquity;AccessonCollegeCampusesKeywords:ProgramInnovations,CampusCollaboration,ChronicDisease,Access,EquityProgramTitle:AccessibilityToolkitforStudentsLivingwithDiabetesProgramAbstract:Studentswithdiabetesmayfacedifficultyinproperlynavigatingaccessibilityservicesontheircampus.Duetothenatureofdiabetesasaself-care/self-advocacydisease,studentsmaynotseekaccommodations,orevenrealizethattheyqualifyforaccommodations.Asdiabetesandotherchronicillnessescontinuetogrowinthecollegeagedpopulation,campuseswillneedtoembraceinnovativestrategiestoengagestudentswiththeseconditions.Withoutseekingtheassistanceofaccessibilityservices,thesestudentsmayfaceunduehardshipincollege.Inresponsetothedisconnectbetween

studentsandaccessibilityservices,theCollegeDiabetesNetworkassembledaCampusAdvisoryCommittee,amulti-disciplinaryteamofcampusprofessionalsandorganizationalpartnerscommittedtosupportingyoungadultswithdiabetes,toidentifythegapsfacedbythispopulation.TheCollegeDiabetesNetworkhopestobridgethesegapsbydevelopingatoolkitforcampusaccessibilitystafftohelpbettersupportthesestudents.ProgramDescription:SincethefoundingoftheCollegeDiabetesNetwork(CDN),campusadministratorsandclinicalprovidershavesharedincidencesofstudentsdroppingoutofcollegeduetothedifficultyassociatedwithdiabetesmanagementwhileoncampus.Additionally,studentshavealsoreportedtheirstrugglesinnavigatingcampuslife,resultinginnegativepsychosocialandphysicalhealthoutcomes.Whilemanystudentslivingwithdiabetesdofindeffectivewaystobalanceself-careandcollegelife,thechallengesmanystudentsmayfacecannotbeignored.Notonlycanthesedifficultiesaffectthestudent’soverallhealth,itmayalsoaffecttheirabilitytothriveacademicallyandsociallywhileincollege.Toaddresstheseissues,CDNassembledtheCampusAdvisoryCommittee(CAAC),amulti-disciplinaryteamofcampusprofessionalsandorganizationalpartnerstoassessthegapswhichstudentswithdiabetesmayface.ThroughtheworkoftheCAAC,CDNhadidentifiedchallengescampusesmayfaceinservingthispopulation,anddevelopedaroadmapforanewprogramminginitiativethroughCDNtoaddressthesegaps,andassistcampusprofessionalsinprovidingequitablesolutionstobettersupportthispopulation.ThecommitteewasassembledonJuly29th-July31st,inBoston,Massachusetts.Overthecourseofsummitmeeting,thecommitteeidentifiedtwomajorgapswhichattributetothestrugglesofstudents.Thosebeingself-advocacyburnoutandthelackofawarenessamongststudentswithdiabetesofdiabetesbeingaqualifierforacademicaccommodationsundertheAmericanswithDisabilitiesAct.Diabetesisalmostentirelyaself-carecentereddisease.Thismaydrivestudentstoapointinwhichtheyareexhaustedwithconstantself-advocacy.Itwastheopinionofthecommitteethatinorderforstudentstoreachtheirmaximumpotential,campusprofessionalsmusthelptofacilitatetheshiftofthefullburdenofadvocacyfromthesolelythestudent,andensureopenandhonestchannelsofcommunicationtoensurestudentaccessandsuccess.Thecommitteealsotookunderconsiderationthedifferencesamongcampuseswhichmayleadtodisconnectsbetweenstudentsandaccessibilityservices,suchaslackof/limitedfundingandstaff,limitedtraining/knowledgeinthesectorofdiabetes,andcampuspolitics.Intheefforttoensurethatthesolutionstothesegapscanbeimplementedatcollegecampusesofanytypeandofanysize,thecommitteedevelopedtheconceptfortheCampusToolkitforDisabilityServiceCoordinators.Thetoolkitwillservetoeducateandassistdisabilityservicecoordinatorsastohowtheycanengagewithstudentswithdiabetestoremovetheonusandconstantself-advocacyfromthestudents.Eachtoolkitwithincludegeneralinformationregardingthementalandphysicalburdenswhichcanbecausedbydiabetesinordertobetterinformthetypesofaccommodationswhichthesestudentsmayapplyfor.Thetoolkitwillbedevelopedin2017andpilotedat25campusesnationwide.Usingevaluationsfrompilotcampuses,thetoolkitwillbeformallylaunchedin2018.ThissessionwilldetailthevisionofCollegeDiabetesNetworkastohowcampusadministratorsandstudentscanbetterconnecttoensureequityandexcellenceinthesupportofstudentslivingwithdiabetesoncampus.Further,thefindingsoftheCampusAdvisoryCommitteewillbediscussed,andthedevelopment,testing,andcontentsoftheCDNCampusToolkitforDisabilityServiceCoordinatorswillbe

outlinedanddiscussed.Ifsessionattendeesareinterested,theywillbeprioritizedaspilotrecipientstoreceivethetoolkit.Outcomes:1.)Understandtheimpactdiabeteshasonastudents’academicandsocialsuccessatcollege,andwhataccommodationsarecommonlyrequestedbystudentswithdiabetes.2.)Understandtheresourcesandmaterialsavailabletocampusprofessionalsanddisabilityservicecoordinatorstoassistinsupportingstudentswithdiabetes.3.)BeabletoassesstheneedforaprogramsuchastheCDNCampusToolkitforDisabilityServiceCoordinatorsontheirowncampuses,andelecttorequestapilottoolkit.PreferredSessionLength

• 60-minuteconcurrentsessions:Break-outpresentations.Amaximumof12presentationswillbeofferedsimultaneously,andinsomeconcurrentblockstherewillbefeweroptions.

• 60-minuteroundtablepresentations:Thesehighlyinteractivediscussionsessionsshouldfocusonaprovocativeorinnovativetopic.Proposersshouldbesuretohighlightdiscussionquestionsandexpectedoutcomesintheirpresentationdescriptions.Bynecessity,theaudiencesizewillbelimited.

• AHEADTalks(15-20minutes):RecognizingtheimpactofTEDTalks,weareexcitedtoexploretheeffectivenessofshort,dynamictalksinpresentingprovocative,novel,andinspirationalideasthatchallengetraditionalperspectives.ConferenceplannerswillworkcloselywiththoseacceptedtopresentAHEADTalkstoofferguidanceandreview.

Presenters:MargaretCamp|MeD,DirectorofStudentAccessibilityServices,ClemsonUniversity,AHEADrepresentativeTomThompson|InterimDirector,DisabilitySupportServices,CaliforniaStateUniversity–Fullerton,AHEADrepresentativeCharlesRiley|Student,CDNChapterleaderofDOSESatOhioUniversity

Physics

ResearchandProgramDevelopmentDiabetesFactSheetforStudents

DiabetesOutreachSupportandEducationforStudentsinCollegeKnowledgeabilityStudy

Creatingadiabetesfriendlyclassroom

DOSES: Diabetes Outreach, Support and Education for Students For more information contact DOSES at doses@ohio.edu

In case of emergency call 911 or the OUPD at (740) 593-1911. What is diabetes?- Diabetes is any metabolic disorder resulting in chronic polyuria (excessive urine output).- Diabetes mellitus is the most prevalent. - Type 1 accounts for 5% to 10% of cases in the U.S., and is an autoimmune disease. - Type 2 accounts for 90% to 95% of cases in the U.S., and results from insulin resistance.

What’s in a number?- Normal blood glucose level: 70-100 mg/dL- Blood glucose levels can fluctuate during times of stress (e.g., midterms or finals), illness, and exercise. - Running to class is the #1 cause of hypoglycemia for students with diabetes.- Hypoglycemia is a condition characterized by abnormally low blood glucose levels (less than 70 mg/dL is a LOW). - Hyperglycemia is the technical term for high blood glucose levels (greater than 180 mg/dL is a HIGH).

What is considered a diabetic emergency?- Severe hypoglycemia can lead to seizures, unconsciousness, coma, and even death. If you notice any of these symptoms, dial 911 immediately.- While you wait for help to arrive, see if anyone in the room has raisins, juice, regular soda, hard candies, anything that could help raise the student’s blood glucose levels.- The student may also be carrying a glucagon pen, which can be injected into the individual’s buttock, arm or thigh to treat a severe hypoglycemic event.

What can you do to help?- Students are not required to disclose, so look for the blue DOSES wristband, part of the welcome kit they receive when they register with Student Accessibility Services.- Include language in your syllabus encouraging students to come to you with…- Permit diabetic students to eat or drink during lecture to avoid hypoglycemia.- Allow diabetic students to adjust their insulin pump or check blood glucose levels during class. Insulin pump alerts may sound like a cell phone.- Be flexible. In case of blood glucose emergencies, excuse students from class and accept a medical provider’s note at a later date. Also be aware that students with diabetes may be late to class because they had to treat their diabetes symptoms.